Wiki Denial of cpt code 27496

[jenkins62]

HUMANA DENIED MY CLAIM
HELP!

I BILLED CPT CODE 27496 (Decompression fasciotomy, thigh and/or knee I compartment)
with ICD 9 CODE 958.92 (Traumatic compartment syndrome of lower extremity)

*1st DENIAL WAS BECAUSE THE ICD 9 CODE DID NOT MATCH THE CPT CODE/I SENT CODING COMPANION FOR ORTHOPAEDICS PAGE STATING THEY MATCH, APPEAL LETTER, OP-NOTE ECT.

*2ND DENIAL WAS BECAUSE MEDICAL RECORDS SUBMITTED DO NOT SUPPORT THE DIAGNOSIS AND PROCEDURE THAT WERE DONE. THIS SERVICE WAS NOT COVERED AS IT WAS NOT MEDICALLY NECESSARY. THEREFORE, DENIAL OF PAYMENT

WHAT DO I DO? ASK DOCTOR TO DICTATE LETTER?

HAS ANYONE ELSE HAD THIS PROBLEM? HOW CAN I GET IT PAID?

OP-NOTE

DIAGNOSIS: LEFT LOWER LEG EXCERCISE INDUCED COMPARTMENT SYNDROME

PROCEDURE PERFORMED: LEFT LOWER LEG ANTERIOR FASCIOTOMY AND LEFT LOWER LEG LATERAL FASCIOTOMY

I BILLED 27496 W/ 958.92 ****WAS THIS CORRECT?

 

[mitchellde]

Where did the compartment sydrom come from you coded for traumatic, the little bit of info you provided states induced compartment syndrom which does not sound like traumatic... can you provide all the information for review?

 

[josephmglick]

I would look at 729.72, Nontraumatic compartment syndrome of lower extremity.