Documentation for CPT 25301

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I have received a couple of denials for CPT 25301 as "services not documented in the patient's medical records" after they have been reviewed by Orthonet. My surgeon disagrees. Does anyone have a good example of the documentation requirement for "tenodesis at wrist, extensors of fingers?
 

SharonCollachi

True Blue
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I have received a couple of denials for CPT 25301 as "services not documented in the patient's medical records" after they have been reviewed by Orthonet. My surgeon disagrees. Does anyone have a good example of the documentation requirement for "tenodesis at wrist, extensors of fingers?

My first thought is, did you actually SEND records? I have been getting denials lately from several different companies with that same reason, but we never sent records. I respond by sending the records, and a cover letter stating that their denial is disingenuous at best, or a fraudulent attempt to avoid paying for a legitimate covered benefit at worst. I ALWAYS call them out on their BS.
 
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My first thought is, did you actually SEND records? I have been getting denials lately from several different companies with that same reason, but we never sent records. I respond by sending the records, and a cover letter stating that their denial is disingenuous at best, or a fraudulent attempt to avoid paying for a legitimate covered benefit at worst. I ALWAYS call them out on their BS.
Yes. In each of these cases Orthonet has requested medical records for post procedural review and denied as not documented in the medical record. I agree though, I think its BS!
 

SA91

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I have received a couple of denials for CPT 25301 as "services not documented in the patient's medical records" after they have been reviewed by Orthonet. My surgeon disagrees. Does anyone have a good example of the documentation requirement for "tenodesis at wrist, extensors of fingers?
Have you tried submitting procedure photos/pictures along with the OP reports/medical records?
 
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