Slraheb
Guest
Hi,
Our provider saw a patient that had a previous surgery which involved a advanced flap repair to restore nasal function and was pleased with her healing but has had persistent difficulty breathing. The provider assessed that the procedure to be performed to correct this problem should not be considered cosmetic. Her goal was to perform the simplest mode of improvement with a simple repair (no prior auth needed) but after identifying a significant amount of scar tissue in her nose from a previous surgery and rather than close the patient up and have to reopen her to perform what was needed to restore her breathing a 30465 was completed (nasal valve stenosis or widening of nasal passage). It was denied for no prior authorization, I sent in all of the doctors notes, patient notes etc. and it was still denied. Any suggestions on how I can appeal this? The provider performed what was necessary and felt it was not in the patient's best interest to close her up to get prior auth to just to open her up again.
Our provider saw a patient that had a previous surgery which involved a advanced flap repair to restore nasal function and was pleased with her healing but has had persistent difficulty breathing. The provider assessed that the procedure to be performed to correct this problem should not be considered cosmetic. Her goal was to perform the simplest mode of improvement with a simple repair (no prior auth needed) but after identifying a significant amount of scar tissue in her nose from a previous surgery and rather than close the patient up and have to reopen her to perform what was needed to restore her breathing a 30465 was completed (nasal valve stenosis or widening of nasal passage). It was denied for no prior authorization, I sent in all of the doctors notes, patient notes etc. and it was still denied. Any suggestions on how I can appeal this? The provider performed what was necessary and felt it was not in the patient's best interest to close her up to get prior auth to just to open her up again.