03/29/2023

BCBS Denial for 29292 RT Foot and Toe Arthroplasty (2&5)-Same Foot

Hi Hoda, I did a 29292 on the right foot and arthroplasty on toes 2&5 same foot submitted to BCBS and they denied due to wrong modifiers. Dx codes m20.11 was billed with 28292-rt, dx code m20.41 was billed 28285-59-t6, 28285-59-t9. Please advise as I need to get denial from bc (OON) toi bill UHC(nyship) out of network. Thanks

The claim was denied by Blue Cross because of an incorrect modifier for the bunionectomy. A replacement claim needs to be submitted with the -RT modifier corrected to -T5. In addition, the -59 modifiers used in the hammertoe corrections need to be removed because they are unnecessary (the surgery was performed on different toes). Once corrected, this should be processed as an OON claim where patient responsibility can be billed to the Empire Plan as secondary.