Hi all -
I hope someone can shed a little light here.... We have a patient who had two Greenlight vaporizations of prostate (52648) about fifteen months apart. The dictation does not indicate it was a staged procedure. I can not find any documentation that clearly indicates that 52648 is a once in a lifetime procedure, which leads me to believe that it's a policy of Humana to make it a once in a lifetime. So, before we bill the patient, I want to exhaust every option to get the insurance to cough up the cash.
Is 52649 a subsequent Greenlight in the same way the 52630 is a subsequent 52601? OR is there another code to use? OR is there definitive documentation to say one way or another on the once in a lifetime thing? Does anyone have any suggestions on what to say in the appeal?
Thanks in advance!!!
I hope someone can shed a little light here.... We have a patient who had two Greenlight vaporizations of prostate (52648) about fifteen months apart. The dictation does not indicate it was a staged procedure. I can not find any documentation that clearly indicates that 52648 is a once in a lifetime procedure, which leads me to believe that it's a policy of Humana to make it a once in a lifetime. So, before we bill the patient, I want to exhaust every option to get the insurance to cough up the cash.
Is 52649 a subsequent Greenlight in the same way the 52630 is a subsequent 52601? OR is there another code to use? OR is there definitive documentation to say one way or another on the once in a lifetime thing? Does anyone have any suggestions on what to say in the appeal?
Thanks in advance!!!