Wiki hip scope procedures

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nyyankees

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have a question - one of my dr's does a few hip scopes. he will do a labral debridement (29862), synovectomy (29863) and a FAI (29999) - all documented of course.

When we receive an EOB from the insurance company (I don't do follow-up but do get asked questions) they usually don't pay for both the 29862 and 29863 even though it's not part of NCCI edits.

Can anyone shed some light so I can help the girls and myself understand their reasoning behind these denials. thanks.

:(
 
If I was thinking like an insurance company, my reasonig for the denial would be that when doing the synovectomy the doc has to debride his way there. It's incorrect though, so I'd have to have a discussion with the insurance rep and have copies of the edits to show him/her. You may have to get the claims reviewed by the Medical Director of the Insurance a few times, but it can get good results if you keep on them.

Good Luck with it!
 
thanks...after your first reply I thought the dx codes were not specific enough. Been looking for better labral tear hip dx codes, FAI dx codes and hip synovectomy dx codes to be more specific.

Will do more investigation into these denials.:D
 
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