Wiki problem with Unitedhealth care paying


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I have been billing Unitedhealth care for over 2 yrs for a procedure my doctor performed. He consulted the patient, then took her to surgery for an ruptured appendix. While in the area, he did a drainage of ovarian cyst. I coded this 99254-57
Unitedhealth paid for consult and drainage, but state the appy was coded wrong. I have sent this in several times with op report and medical records and they still say wrong coding. The surgical assist, who is employed by doctor, received payment for both procedures w/80 modifier- no questions. But Dr's charges are billed wrong.

Can anyone HELP- I am getting very upset about this and getting the run around. I have spoke to 8 different people since Aug 2008 along- not telling how many before that time.
Since this has occurred, I now live in NC and Dr in IL and is retired.
The rep we had prev- was NO help
I no longer do appeals and such so I no longer have my contacts, but I do know that UHC has a 2nd Level Tier...I'm sure if you've spoke with 8 people already you have probably already reached that level, but they were always helpful.
UHC has done the same thing to us time and time again.If provider relations aren't helpful, you do have other alternatives. I haven't had to do this often but I have filed a grievance with the Insurance Commissioner and payment was eventually collected. Another CPC that I know states that UHC has created their own medical condition:

Neuro-opticrectosis: The optical and rectal nerves become intertwined and you get a dirty, smelly outlook on life.:eek:

Little humor for a Friday afternoon...
CPT says Mod 52

CPT 2008 professional edition Pg 204, under 44950 (yes, I know, you are billing 44960) there's a parenthetical remark that tells you to use mod 52.

Or ... UHC may want you to code 44955 as the add-on to the drainage (I know this doesn't make sense because the reason you opened the patient was the ruptured appy and not the ovarian cyst... but I'm trying to think like UHC ... and I'm getting a headache ... Becca ... what's the ICD9 for Neuro-Optirectosis?

So UHC may prefer to see



F Tessa Bartels, CPC, CPC-E/M