Podiatry Surgery - Open repair of Talus fracture with Brostrom repair ankle

edward1216

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Need help from Podiatry Surgery Coders:

Billed 28445 with 27698. Both codes were denied by Medicaid as not being documented (but it is in the notes)
29898, 20600 and 76000 were paid.

Description of the Procedure absolutely describes the op procedure repairing the Talus.

Does anyone have any experience with any denials with this surgery regarding billing of the above codes.

Really appreciate any help on this. I'm new to Podiatry coding.
Thank you!

Arlene, CPC
acastello825@gmail.com
 

Orthocoderpgu

True Blue
Local Chapter Officer
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How I do appeals

I have appealed a ton of surgeries over the years. For me I like to print out the code(s) that were performed from the coding companion. And then I underline the "meat" of the surgery, where the procedure is really being performed and not all the "cutting down to" part of the code description.

Then I underline the op note where the procedures were performed and write the code out on the side.

To be sure, the person at the insurance company that will read the appeal is probably not familiar with the procedures and has no professional experience with them. Count on it.

It does not always work, but it's the best way to educate the insurance company.

If the procedure is well documented in the op note, I would ask for a peer to peer review in your appeal. Insurance companies don't like peer reviews because they usually don't have anyone there that is familiar enough with the procedure(s) to speak about it. Your physician will have to educate the person from the insurance company more than likely about the procedure and how it's performed.

Keep in mind that I worked for a national insurance company before jumping ship and working for the physicians.
 
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edward1216

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Thank you for your help..like your appeal process; have also found peer to peer good

Thank you for your take on the Podiatry issue...I appreciate your time and information.
 
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