Lbooth110
Contributor
I received a denial from insurance stating that after they reviewed the operative report there is a more appropriate code for the perineoplasty 56810. I contacted the insurance and requested what they thought the appropriate code was. I would then review myself and present the code to the physician that performed the surgery to see if she felt that the code would be appropriate as well. But the insurance stated that we would have to appeal. And there is still no gaurantee that they would then inform us of what they thought was the appropriate code.
The procedure was LTH, laparoscopic colpopexy, rectocele repair, enterocele repair and a perineoplasty.
58570
57425
57250
57268
56810
The insurance denied both the 57268 & 56810..Eob states 57268 records indicated procedure code billed is not substantieated and is not covered , pt not resp. ...56810 alternate procedure code is more appropiate. The only other code I code come up with would be the Labial plasty...15839
all other codes processed and paid.
the procedure report that did not get paid:
Two allis clamps were placed on the hymenal ring, and a horizontal incision was made between the two. Posterior vaginal mucosa was undermined to the level of the cuff and separated from the underlying tissue on either side usion sharp and blunt disection. A doubly gloved finger was placed in the rectum . 0 Vicryl was applied with a
Capio suture applier, the first two in the sacrospinous ligaments and the scond two in the lateral fascial point. At this point, a few acnhoring sutures were placed using 0 Vicryl.
Approxximately 1 cm of mucosa was removed from either side. The vaginal mucosa was repaired using 0 Vicryl in an interrupted figure of eight fashion. This successfully reduced the rectocele and the enterocele. When the perinum was reached., a Vshaped incision was made int he perineal body. The two sides of the perineal body were approximated using 0 Vicryl. Skin and mucosa were approximated using the 2-0 Vicryl. Iodoform packing was placed. patient to recovery..
What do you all think is could possibly be?
Thank you in advance for your coding help
Lisa
The procedure was LTH, laparoscopic colpopexy, rectocele repair, enterocele repair and a perineoplasty.
58570
57425
57250
57268
56810
The insurance denied both the 57268 & 56810..Eob states 57268 records indicated procedure code billed is not substantieated and is not covered , pt not resp. ...56810 alternate procedure code is more appropiate. The only other code I code come up with would be the Labial plasty...15839
all other codes processed and paid.
the procedure report that did not get paid:
Two allis clamps were placed on the hymenal ring, and a horizontal incision was made between the two. Posterior vaginal mucosa was undermined to the level of the cuff and separated from the underlying tissue on either side usion sharp and blunt disection. A doubly gloved finger was placed in the rectum . 0 Vicryl was applied with a
Capio suture applier, the first two in the sacrospinous ligaments and the scond two in the lateral fascial point. At this point, a few acnhoring sutures were placed using 0 Vicryl.
Approxximately 1 cm of mucosa was removed from either side. The vaginal mucosa was repaired using 0 Vicryl in an interrupted figure of eight fashion. This successfully reduced the rectocele and the enterocele. When the perinum was reached., a Vshaped incision was made int he perineal body. The two sides of the perineal body were approximated using 0 Vicryl. Skin and mucosa were approximated using the 2-0 Vicryl. Iodoform packing was placed. patient to recovery..
What do you all think is could possibly be?
Thank you in advance for your coding help
Lisa