Wiki 62165-62, 15740

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MFiggy

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Hello Everyone,

So I'm having a problem in Florida with Aetna and BC (only all other insurances are processing with no issue) when billing the ENT assist 62165-62 with 15740. The continue to deny the 15740 citing Skull base surgery from a Neurologist standpoint. The last article I found was from the AAO-HNS Bulletin April 2013 stating to use an unlisted code 31299 for the ENT. I've tried to reach out to Karen Zupko and they only copied me someone else's question which says its ok to bill these two together but can't provide me a source to cite in my appeal. Zupko's site also shows the 2013 article, so I'm at a loss and I have a couple of surgeries I need to appeal. Can anyone help me?
 

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MFiggy, I read the op note. Doctor documented a "pedicled septonasal flap which was laid down. At first, I thought that there is no "anatomically named axial vessel" which is required for 15740 but I found it up higher in the op note, during the harvest of the flap, stating that it is the "internal maxillary artery (feeding branch sphenopalatine artery) on the left side. The reason that the 2013 says to not use the 15740 code is because the code includes skin and the flap placed in the septum does not include skin. Given that logic, I guess using 30999 is appropriate, but I would equate it to 15740 in box 19 for pricing.

I will continue to research and let you know if I find out anything else.
 
b.cobuzzi said:
MFiggy, I read the op note. Doctor documented a "pedicled septonasal flap which was laid down. At first, I thought that there is no "anatomically named axial vessel" which is required for 15740 but I found it up higher in the op note, during the harvest of the flap, stating that it is the "internal maxillary artery (feeding branch sphenopalatine artery) on the left side. The reason that the 2013 says to not use the 15740 code is because the code includes skin and the flap placed in the septum does not include skin. Given that logic, I guess using 30999 is appropriate, but I would equate it to 15740 in box 19 for pricing.

I will continue to research and let you know if I find out anything else.
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Thank you for your help!!
 
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