Wiki Need code help- open removal fb in bladder

[NStone]

Physician attempted to remove 40+ magnetic metal balls a male patient inserted into his bladder via his urethra/penis. CPT 52315 was converted to an open procedure because the magnets clumped together. CPT code 53899 was billed and the op note/medical records submitted. CareFirst Administrators paid and then retracted payment stating the procedure was denied since it was an unlisted code and has no allowable amount. This was appealed but they have upheld their decision.

Anyone have any other ideas? In the meantime, the patient is receiving the bill.

 

[nateich]

When billing and appealing unlisted codes we have to compare to a "similar" code; 51050? be sure to follow all of the guidelines set forth by CareFirst for a second level appeal. This MUST be appealed, private message me if you need assistance.

 

[NStone]

Thank you. I'll try a second level appeal using 51050 as a comparison.