Dx for graft

Thouvenel

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I am needing some help for diagnosis on a Tricare patient. Doc performed Tympanoplasty w/ mastoidectomy and used a graft, I have never been able to get this graft paid under government insurance using the diagnosis for perf eardrum, what dx should be used for the graft? Any suggestions?
 

nsteinhauser

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You said you've never been able to get 'paid for the graft' -if you are using a 69641-69646 code, you don't code separately for the graft - if you're talking about a graft that covers the tympanic membrane or a graft that replaces part of the ossicles - it's incluuded in the code. Or are you saying you can't get paid for the entire surgery? Perforation of the tympanic membrane should be an acceptable dx for the tympanoplasty but the patient probably had another diagnosis (cholesteatoma, mastoiditis, etc.) to warrant doing the mastoidectomy.
 

Thouvenel

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I apologize, I should have been more clear, CPT code is 69635, and dx is 382.2 chronic atticoantral suppurative otitis media. The procedure is paid, and the repair is paid, but the graft itself did not pay stating invalid dx for this procedure.
 

nsteinhauser

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No apologies necessary - I am perhaps still confused (coders are like that - we think too much)- but - even with the 69635 - payment for the procedure includes the cost of the graft (fascia, fat, etc.) so you wouldn't code separately - it's not reimbursed on top of the reimbursement for the 69635. Does that make sense? So no matter what diagnosis code was attached to it, the HCPCS or CPT that you used for the graft itself wouldn't be separately reimbursable if you already billed for and got reimbursed for the 69635.
 

Thouvenel

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Thank you for your explanation, I didn't realize the graft was included, and all this time I have been billing and getting reimbursement incorrectly, and worse insurance has been paying for it. Thank you again.
 
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