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Otolaryngology Coding Alert

Reader Question:

Avoid Appeals 'Form Letters' If You're Hoping for Success

Published on Wed May 09, 2012

Question: After checking to be sure we haven't made a coding or billing entry error, our practice automatically appeals payer denials using a standard letter. We don't seem to be very successful in ultimately getting payment. How can we improve our appeals process?Montana SubscriberAnswer: Before you begin the appeal process, first check the payer's policies. Check to see if, for example, the payer has a policy that bundles 69210 (Removal impacted cerumen [separate procedure], 1 or both ears) into any E/M services performed on the same day. If you feel the policy is not appropriate given the situation specified in the claim (like, the ENT sees the patient for a sinus infection at the time of the impacted cerumen removal, which is a separate problem), you should appeal and fight the payer. Be sure you follow the payer's appeal procedure exactly. Often, the address to submit appeals to is different [...]
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