Wiki 11951

[tkrol@washingtonfootandankle.com]

The podiatrist we work for has recently started using Leneva allograft/adipose Matrix in patients feet for the replacement of inadequate tissue. The hospital bills for the Leneva and is getting paid. Our doc is using 11951 as the administration code and this is getting rejected by all insurances stating it is cosmetic. Is there a modifier that we should use, or a different code? This is a new product and it is working for the patients.

 

[Orthocoderpgu]

The podiatrist we work for has recently started using Leneva allograft/adipose Matrix in patients feet for the replacement of inadequate tissue. The hospital bills for the Leneva and is getting paid. Our doc is using 11951 as the administration code and this is getting rejected by all insurances stating it is cosmetic. Is there a modifier that we should use, or a different code? This is a new product and it is working for the patients.

You have an up-hill battle since this is used for cosmetic purposes and for post breast reduction surgeries which is why it's getting denied the way it is. Most insurance companies have a MD working as a medical director for them. This is probably the person who you need to get a hold of. A provider rep just won't do it, they are glorified CSR from my experience. Contact the insurance companies and tell them that your provider wants to set up a meeting with their medical director. Obviously restoring the foot's fat pad to reduce pain is not cosmetic. This is a lot of work for 1.2 RVU's but I think we need to keep pushing insurance companies to process and pay claims correctly.