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Wiki Assist for emergency rescue cerclage, twins

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cmcgarry

cmcgarry

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Sioux Falls South Dakota
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Patient is 29 yo at 21 5/7 wks gestational age, dichorionic/diamniotic twin gestation. Presented to the office and was found to have bulging membranes; external os 2.5 cm, internal os 2 cm. A rescue McDonald cerclage was performed, and due to the complexity an assistant was needed. Insurance has denied. We did submit with records, as code 593
20 is assist allowed with documentation. Does anyone have a source for more documentation? Or wording for the appeal? This particular insurance company seems to just not want to ever pay on assists that require documentation. Thanks!
 
I have had success getting these paid by using this cover letter, a copy of the OB/GYN Coding Companion page showing an assistant surgeon is allowed and the OP notes.

DATE:


Insurance Company Name

Patient Name
MEMBER ID:
DOB:
DOS:

I am writing in appeal for the above date of service. Per CCI edits an assistant surgeon is allowed with documentation. The ObGyn/Coding Companion also shows an assistant surgeon is allowed. This procedure does have risks involved, the possibility of rupturing membranes, bladder or bleeding.

Thank you so much for your reconsideration.



Yours truly,

Coding Specialist, CPC

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