Wiki Chemical cauterization for umbilical granuloma

pjlittle

New
Local Chapter Officer
Messages
1
Location
Anchorage, AK
Best answers
0
Since the changes in the CPT 17250 (last update) we have been getting denials from many of the insurance companies. Newborn comes in for first office visit with provider and we us to be able to charge an office visit 992XX with a 25 and the 17250 for chemical cauterization of the umbilical granuloma However since the update they are bundling the 17250 even when we use the modifier 25 with a E/M code. At first I thought that it was because of the update in the icd 10 codes. Since the P83.8 Other specified conditions of integument specific to newborn was what the providers used. However, when I added the 5th digit P83.81 Umbilical granuloma. The insurances are still bundling or denying. My scrubbers don't come up with any NCCI edits. Any suggestions for getting it paid or resources to go to definitively say it should be bundled?
 
I'm having this exact problem right now with Magnacare. I couldn't find anything wrong with either cpt or dx code used, 17250 w/P83.81 and w/a mod 25 on the E/M code. I just got off the phone with Magnacare and they refuse to send back for review indicating that they checked their coding resource and the combination is wrong. They insist that we send a corrected claim. Does anyone have any input on this issue? I will call again to see if I can speak with someone else, but I am still interested if anyone has had this issue and any sort of resolution.
 
I'm having this exact problem right now with Magnacare. I couldn't find anything wrong with either cpt or dx code used, 17250 w/P83.81 and w/a mod 25 on the E/M code. I just got off the phone with Magnacare and they refuse to send back for review indicating that they checked their coding resource and the combination is wrong. They insist that we send a corrected claim. Does anyone have any input on this issue? I will call again to see if I can speak with someone else, but I am still interested if anyone has had this issue and any sort of resolution.

Just got off the phone w/Magnacare and just wanted to update in case anyone is having the same issue. This phone rep told me that she checked their coding resource and it seems the dx is the one causing the denial. There is another code, L92.9 Granulomatous disorder of the skin and subcutaneous tissue, unspecified that we can use and I think this is what they are looking for. Of course the P83.81 is the correct code for the umbilical granuloma, but I'm sending the corrected claim w/the L92.9 and will see what happens. It's frustrating when you code correctly and it's not what certain insurances want.
 
Top