Wiki Maximum units for C9358

[awest]

I have billed a tricare south claim, with the code C9358 (surgimend). I billed 600 units based on the amount used. Tricare allowed 4 units and 1st said it was over the maximum # of units for this code, then after my appeal states the code is on paid in square cm. I cannot find anything that shows that there is a maximum # of units that can be billed for this code. Has anybody had this problem or have any ideas? Thank you for any help!

 

[mitchellde]

600 units? which would be 300 sq cm as the code is base on each .5sq cm. But that is a huge area how much area was documented?

 

[awest]

I had a coding company code it to double check I was billing it correct and they got the same thing. It was a very extensive reconstruction where the surgeon used it to reconstruct both breasts where the implants had ruptured. They used 2 10x15 sheets.
I just can't find any reason that they would only allow 4 units.

 

[mitchellde]

If the sheets were measued in cm then you will probably need to send in the report and all documentation to show what was done and why as that is an unsusal amount.

 

[awest]

I have alread sent an appeal with all the information. The response to my request was that code cannot be billed in square cm. I'm at a loss. My Tricare rep just e-mailed me and said she was able to get someone with PGBA to have the claim reprocessed. I just wanted to find something to back up that there is not a MUE for this code. Thanks for your help.