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58862

alamb93374

Contributor
Messages
10
Location
Morgantown,WV
Best answers
0
Does anyone know if there is an age limitation on this code? One of our physicians performed this procedure on an 11 year old and their insurance carrier is telling me that this code has an age edit of 12-99 years old. All help would be greatly appreciated.
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
Best answers
0
Well, I started with the CPT book, there isn't any limitation there (such as with codes 54160/54161 just for example-because it states the age requirements)... I've checked so many online sites - nothing - no age limit.

I'd appeal the denial - obviously this procedure CAN be done on patients under 12 years of age - it's probably not done very often, but that's not to say it can't be.

Maybe someone else will find something - but I researched and found, no age limit.
 

amolson1325

Networker
Messages
82
Location
Bradenton, Fl
Best answers
0
I also have searched everywhere! I agree with Donna's statement....plus what would be the difference between a 11 year old to a 12 year old?? I would appeal, that doesn't make sense for that particular code. Sorry I couldn't find something concrete! Anyone else??
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
Appeal w/ Op Note

I'd appeal with the op note attached. I work for a pediatric surgery specialty and we occasionally get denials like this. It's a computer programming thing probably .. insurance carrier has certain "edits" pre-programmed to rule-out miscoding. A letter appeal w/ op note attached will force a person to look at this and see that it is correctly coded. It would help, also, if you have a pre-auth for this CPT.

F Tessa Bartels, CPC,CPC-E/M
 
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