Wiki 28470 not preformed

[DrTomsFA]

Provider billed 28470x2
diagnosis: M84.374A

After appealing with chart notes, UHC says that the chart notes do not support that the 28470 was preformed. Dispensal of pneumatic cam walker was documented and diagnostics were preformed to accurately diagnose the fracture. All of this information was in the chart note sent to insurance. I am not sure what to do. This procedure was done, but I don't know what the insurance company requires to "prove" that is was. Anything helps.

EDIT: Per the chart note that was sent into UHC, this is the phrasing under the plan for the 28470: "Per proper ICD billing and coding, closed treatment metatarsal stress fracture 2nd and 3rd right foot instituted DOI is today date"

P.S. I'm new so of this is the wrong forum if you could please direct me to the correct one.

 

[cclarson]

Can you post the patient operative report?

 

[DrTomsFA]

Can you post the patient operative report?

Thank you for the response. There is no operative report. From what I understand we have never done operative reports for this code since it opened in 2015. There is only what I posted from the OV.
If there was what would it say? Sometimes patients are put in a CAM walker, sometimes a surgical shoe, and sometimes nothing?

 

[cclarson]

This article might help. https://www.aapc.com/blog/49512-dis... report is perhaps,the results of the surgery

 

[DrTomsFA]

This article might help. https://www.aapc.com/blog/49512-dissect-an-operative-report/#:~:text=The operative report is perhaps,the results of the surgery

Thank you. Do you have a template for a Op note for a closed treatment without manipulation? I would like to present this to the doctor.

 

[cclarson]

Thank you. Do you have a template for a Op note for a closed treatment without manipulation? I would like to present this to the doctor.

I'm afraid I do not have a template personally, the templates usually differ from doctor to doctor, as well as facility. However, I'm sure there may be a few examples floating around online that could help.

 

[Orthocoderpgu]

Thank you. Do you have a template for a Op note for a closed treatment without manipulation? I would like to present this to the doctor.

There is no such thing as a template for an op note for a closed fracture without manipulation.

 

[kimberlywatson]

There is no such thing as a template for an op note for a closed fracture without manipulation.

I agree. Nothing was performed - it's just closed fracture treatment. If the provider states that in his plan, that should be sufficient documentation.