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29862 Experimental

N

nyyankees

True Blue
Messages
1,271
Location
Smithtown, NY
Got a good one here. Empire/UHC denied CPT codes 27036, 29862 and 29863 and unlisted 29999 (posas lengthening). They paid us first, then took the $$$ back stating all 4 procedures were experimental. Has anyone had this issue before? Any good ideas how to defend this? I will use AAOS articles but I may need a little more info. Thanks.
 
UHC hays a policy about procedures for Femoracetabular Impingement, that they will not pay for. I'm not sure about your other procedures, but I have had it happen when I bill 29862 and 29999. When you submit the Operative note, and if it mentions that above DX, they may resort to their policy.

You may find some help here:

www.aetna.com/cpb/medical/data/700_799/0736.html

www.aaos.org/news/aaosnow/jun08/clinical3.asp

Also go onto unitedhealthcareonline.com and do a search.

We have patients sign waivers for this and explain that their insurance may do this.
 
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