19499 is being denied to 19357

dillon091909

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Has anyone heard of medical insurances paying on both 19357 and 19499 in the same operative session. I am having Medicare, UHC and BCBS that are denying the 19499 as included in 19357. I see don't see anywhere that 19499 is global to 19357. Please Help!
 

CodingKing

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19499 is an unlisted code. Its considered "special report" which means supporting documentation is required to show what its reporting. You can not tell by the code alone what its for.

Did you send documentation ? Many payers follow what CPT says is required documentation


Special report
A service that is rarely provided, unusual, variable, or new may require a special report. Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.
 

dillon091909

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19499 is for the Spy Elite Imaging System which I know it's not included in 19357 breast reconstruction. UHC, BCBS and Medicare are a few that are denying the 19499 stating that the Spy Elite imaging is included in the breast reconstruction. I have attached the white pages on coding the Spy Elite.
 

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  • SPY Coding Whitepaper August 2014.pdf
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CodingKing

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It sounds like the payers don't consider the use of the technology in the procedure to warrant additional reimbursement. Payers can bundle whatever they want into the primary surgery. The whitepaper recognizes that payers aren't paying extra for use of the newer technology.

The SPY Elite is the first and most advanced fluorescence imaging system that enables surgeons performing open procedures, such as breast and other reconstruction, gastrointestinal and cardiothoracic surgery, to visualize microvascular blood flow and perfusion in tissue intraoperatively. The SPY Elite provides images that may assist surgeons in making critical decisions in the operating room, which can reduce rates of postoperative complications and decrease healthcare costs.
 
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