Provider performs Septoplasty (30520) in the office (POS 11) and uses a BioDesign Sinonasal repair graft (C1763) instead of patient's own tissue. We tried filing the BioDesign graft to insurance (commercial plans, he/she is not contracted with Medicare) using C1763 but it denies as "not otherwise classified or unlisted" procedure was billed when there is a specific procedure code for this procedure or service and this should be billed with the appropriate code for these services.
After a few of these denials the provider decided he/she would not include it on the claim and would make the patient pay cash for the Biodesign graft (he/she has the patient sign an ABN he/she customized for this specific service even though it is not a Medicare patient and is not included on the claim).
Questions:
1. Is there another CPT/HCPCS code that the BioDesign graft should be billed with?
2. Does a customized ABN apply for commercial insurance and allow the patient to be directly?
3. Would the graft be included in the reimbursement of the septoplasty whether it was patient's own tissue or biologic replacement and shouldn't be billed to insurance or the patient?
Thank you for your input.
After a few of these denials the provider decided he/she would not include it on the claim and would make the patient pay cash for the Biodesign graft (he/she has the patient sign an ABN he/she customized for this specific service even though it is not a Medicare patient and is not included on the claim).
Questions:
1. Is there another CPT/HCPCS code that the BioDesign graft should be billed with?
2. Does a customized ABN apply for commercial insurance and allow the patient to be directly?
3. Would the graft be included in the reimbursement of the septoplasty whether it was patient's own tissue or biologic replacement and shouldn't be billed to insurance or the patient?
Thank you for your input.