mardi 5 mai 2015

29824 Denials

I recently received a denial from Humana, which used Orthonet to review the operative note; they denied 29824 Distal Claviculectomy stating that the procedure wasn't documented per AAOS the note but state that at least 8-10 mm of bone was removed. Has anyone had any problem with this code if the physician didn't actually state this but he said to me that

"That's ridiculous. That's exactly what the procedure is. I can start throwing in some statement about how much bone was removed but, by definition, it's 8-10 mm. So it will be a superfluous and unnecessary step, but, fine. Do I get him to do an addendum to the operative note and appeal with the addendum, or is it a way I can appeal without the addendum? Please advise



29824 Denials

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