Wiki DENIAL FOR HERNIA CODE 49596

[tng141@aol.com]

Hello Everyone! I am needing some advice on a denial I received for CPT code 49596. This procedure was done in an outpatient setting (22) and Anthem Medicare is stating they are denying this claim because this CPT code is only
allowed in an inpatient setting (21). Has anyone ever received this denial before? If so will Anthem Medicare pay once disputed? I cant seem to find any articles explaining if this is an inpatient code only. Thank You all in advance.

 

[lindam@caricures.com]

This is just a guess, but maybe because of the size of the hernia and that it wasn't reducible that is what makes it inpatient?