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Wiki Omental Flap denying for Qualifying Service

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jojokat

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Provider performed a 44160, 47100 and 49905. Cahaba is denying the 49905, omental flap, stating that "the related or qualifying claim/service was not identified on the claim". I contacted Cahaba, but they were of no help. There is not an NCD nor LCD for the procedure and it doesn't hit on any of the CCI edits. :(

Does anyone know what qualifying or related service they are referring to? I have been unable to find this information to get this service paid.

Any help would be greatly appreciated.

Thanks,
Josie
 
49905

CPT 49905 is by definition an add on code. There is not a set of codes that can be used with this CPT, however Super Coder states that this code may be reported in addition to any primary procedure in which an omental flap is used
 
43840 with a graham patch is not the same as a flap. I doubt they did a flap just a patch which is bundled. as far as your flap denial, I would appeal with notes
 
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