I have a denial from a payer who states that the capsulotomy which was billed separately will not be reimbursed because the payer considers it to be "integral" to the success of the revision.
Here are the ops notes for the procedure..."Fat grafting was performed using10cc syringes and Coleman grafting cannula, types 1, 2 and 3. The following amounts of fat were granted into the follwoing areas: Right medial breast 12 ml, left medial breast 9 ml, left superomedical breast 15 ml, right superomedial breast 5 ml and left superolateral breast 5 ml..."
Based on what was in the notes, I think we probably shouldn't have billed the revision code, just the capsulotomy. Am I wrong? Do I have grounds for an appeal here?
Here are the ops notes for the procedure..."Fat grafting was performed using10cc syringes and Coleman grafting cannula, types 1, 2 and 3. The following amounts of fat were granted into the follwoing areas: Right medial breast 12 ml, left medial breast 9 ml, left superomedical breast 15 ml, right superomedial breast 5 ml and left superolateral breast 5 ml..."
Based on what was in the notes, I think we probably shouldn't have billed the revision code, just the capsulotomy. Am I wrong? Do I have grounds for an appeal here?