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Wiki Documentation for CPT 25301

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Jaefitzy16

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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?
 
Jaefitzy16 said:
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?
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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.
 
SharonCollachi said:
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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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!
 
Jaefitzy16 said:
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?
Click to expand...
Have you tried submitting procedure photos/pictures along with the OP reports/medical records?
 
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