Wiki Question - Community Health Network denied

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Bella Cullen

Bella Cullen

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Hello,

Has anyone ever encountered this problem:

Community Health Network denied G0289 stating No fee set by DSS. Is there anything to do about this? :confused:

I appreciate any help on this.

Thanks,

Melissa
 
I don't believe G0289 is on the fee schedule for Community Health Network. At least not here in Washington. What CPT were you replacing with G0289? Try resending claim with 29877 or 29874.
Jenna
 
Well I thought of replacing that with 29877 but the only problem with that is I also billed 29882 and 29875 on that claim and 29877 is not billable with 29875 so I don't think that will work.

Thanks for your responses.
 
In this case you can not use 29877 it can not be billed with any other code, How much is your charge for the G0289?
I would bill the G0289 and advise that it is a add on code, If denied you should appeal, Our office has ran into some problems and after a appeal with have been paid. Good luck
 
ILuvRock said:
Well I thought of replacing that with 29877 but the only problem with that is I also billed 29882 and 29875 on that claim and 29877 is not billable with 29875 so I don't think that will work.

Thanks for your responses.
Click to expand...

What different compartments are we dealing with here?
 
ivonneatanacio said:
In this case you can not use 29877 it can not be billed with any other code, How much is your charge for the G0289?
I would bill the G0289 and advise that it is a add on code, If denied you should appeal, Our office has ran into some problems and after a appeal with have been paid. Good luck
Click to expand...


But the problem is G0289 is not on their fee schedule so this is what I'm not sure of. There is no fee for that code.

Thanks.
 
The G0289 is a code that is carrier discretion, if this carrier goes by CCI edits and does not recognise the G code there is no way to be reimbursed for that procedure.
 
ILuvRock said:
Medial and patellofemoral compartments.
29882 medial
29875 medial
G0289 patella
Click to expand...

I am not quite sure why you would have coded the 29875 with the 29882 since they are in the same compartment, the 29875 bundles with 29882 and a 59 would not have been justified in the same compartment.

I would rebill this as a corrected claim using 29882 and 29877-59. This carrier does not recognize G0289 thats why its not on their fee schedule.

I know that some people have some carriers that want the G0289 in some parts of the world, however I (knocking on wood) am still able to use the 29877 for all of my commercial carriers without any problems :)
 
mbort said:
I am not quite sure why you would have coded the 29875 with the 29882 since they are in the same compartment, the 29875 bundles with 29882 and a 59 would not have been justified in the same compartment.

I would rebill this as a corrected claim using 29882 and 29877-59. This carrier does not recognize G0289 thats why its not on their fee schedule.

I know that some people have some carriers that want the G0289 in some parts of the world, however I (knocking on wood) am still able to use the 29877 for all of my commercial carriers without any problems :)
Click to expand...

Oh, I didn't even think of that, I thought it was 2 different things because the meniscus was just repaired with sutures, and the plica was excised and debrided so I thought they were 2 different.

Yeah this is the only insurance that doesn't recognize this. All other ones require us to use G0289 instead of 29877 when billed with other procedures on the same day.

Thanks for your help.
 
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