CPT codes- 21235,30140,30420

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16
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Received authorization from UHC for these codes. 16 year old male with 10 year history of moderate to severe saddle nose deformity and severe deviated septum, visible to eye. We have never billed these codes together and wondering if anyone has had success in getting paid or will this be a long appeal battle.

Mercy
 

JenniferB7

Guru
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214
Location
Victoria, TX
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Mercy -

I have gotten payment for all of those codes, but only with strong documentation (provided the patient's benefit plan covered the procedures). Make sure your surgeon documents each procedure thoroughly.

If you are really concerned, you can always request a predetermination prior to surgery, which gives an even great likelihood that all of the claims will be paid. In our office, we always require a predetermination for CPT 30410. Even when medically necessary, many policies still exclude benefits for this procedure.

You can also use United Healthcare online (under claims --> Claim Estimator) to submit a predetermination of benefits and to check the bundling edits for those procedure codes.

Hope that helps!

Jennifer M. Connell, BA, CPC, CPPM, CPCO, CENTC
 
Messages
2
Location
Leesburg, FL
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0
Mercy -

I have gotten payment for all of those codes, but only with strong documentation (provided the patient's benefit plan covered the procedures). Make sure your surgeon documents each procedure thoroughly.

If you are really concerned, you can always request a predetermination prior to surgery, which gives an even great likelihood that all of the claims will be paid. In our office, we always require a predetermination for CPT 30410. Even when medically necessary, many policies still exclude benefits for this procedure.

You can also use United Healthcare online (under claims --> Claim Estimator) to submit a predetermination of benefits and to check the bundling edits for those procedure codes.

Hope that helps!

Jennifer M. Connell, BA, CPC, CPPM, CPCO, CENTC
30410 or 30140? THE INQUIRY WAS FOR 30140
 
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