Question In office Circ w/ gomco clamp, over 28 days

[DAWNC34]

This is a 1st for me, billed 54150 in office circ (clamp) Insurance denied, 35 days old. I'm not sure what code to bill now? CPT 54161 reads Circumcision, surgical excision other than clamp?
any suggestions?

 

[CBLENNIE]

If the clamp was used then resubmitting the claim with 54161 would be inappropriate since it excludes use of the clamp, you can't change a code just to get paid.

What exactly was the denial reason code or message from the payer as to why they denied the claim since the patient is the proper age for 54150 and the code describes the procedure performed based on the information in your post? Did they deny it as outside the procedure is inappropriate for the patient's age, if not why did they deny it?

 

[DAWNC34]

If the clamp was used then resubmitting the claim with 54161 would be inappropriate since it excludes use of the clamp, you can't change a code just to get paid.

What exactly was the denial reason code or message from the payer as to why they denied the claim since the patient is the proper age for 54150 and the code describes the procedure performed based on the information in your post? Did they deny it as outside the procedure is inappropriate for the patient's age, if not why did they deny it?

Thank you, for responding, I appealed it with notes, CPT Code doesn't have age restrictions. It was a incorrect denial & claim was paid