sjcarlile07
New
Does anyone know if there is any documented information about what is required as far as where the hernia defect size MUST be documented? My surgeon documents it in his pre-op office visit note for 2 reasons; 1. we have to have the size to know what code to get prior auth for, and 2. for documentation of the pre-surgery size.
I have received a Humana post-payment review denying billing 49593 because they are saying that the pre-op size is not documented. I sent them the office visit note, which also suffices for the H&P for the admit, which has the size, to appeal the denial. They are still denying. I don't know if they are truly denying because the hernia ended up being .5 cm larger than the pre-surgery size once the surgeon did the surgery and they are just not wanting to pay for the higher code. Surely they are not saying that you have to bill for the pre-surgery size regardless of what is found during the surgery, right???
I can't find anything about where there is a requirement that this size be documented in a specific place.
I am thankful for any help.
I have received a Humana post-payment review denying billing 49593 because they are saying that the pre-op size is not documented. I sent them the office visit note, which also suffices for the H&P for the admit, which has the size, to appeal the denial. They are still denying. I don't know if they are truly denying because the hernia ended up being .5 cm larger than the pre-surgery size once the surgeon did the surgery and they are just not wanting to pay for the higher code. Surely they are not saying that you have to bill for the pre-surgery size regardless of what is found during the surgery, right???
I can't find anything about where there is a requirement that this size be documented in a specific place.
I am thankful for any help.