mentsa
Networker
We are having a problem with pre-certs for bundle codes. An example is: Pre-cert request was put in for cpt codes 31267-maxillary sinus, 31255-ethmoidectomy, 31287-sphenoidotomy, 30140-resection inferior turbinate, 61782-guidance. When the physician got into the surgical procedure, he found that there was a necessity for a 31276-frontal sinus exploration w/removal of tissue. The 31255 and 31276 should be billed in the bundle code 31253 according to the information we have. The 31276 was not anticipated before the surgery so therefore a pre-cert was not done. One was not done for the bundle code 31253 either and the claim was denied. Is anyone else having any similar situations? If so, have you found a resolution to this?