Wiki Surgical Billing Question

[gordelly1]

During the surgery for removal of retroperitoneal adhesions it was decided to perform a supracervical hysterectomy. I billed for both but they didn't pay for the removal of adhesions. I want to appeal the decision, but is there a way for me to do that and get paid for both?

 

[pattivest]

The removal of the adhesions is going to be considered part of the hysterectomy. Insurance carriers will not pay for both unfortunately.

 

[imjsanderson]

It does also depend on how long the physician spent on the adhesions before making the decision for the hysterectomy, and the documentation. Was it documented the extent of the adhesions? Dense adhesions? The additional time it took? If not, it would be included in the hysterectomy.

 

[gordelly1]

It does also depend on how long the physician spent on the adhesions before making the decision for the hysterectomy, and the documentation. Was it documented the extent of the adhesions? Dense adhesions? The additional time it took? If not, it would be included in the hysterectomy.

According to the Op report, no specific time range was given, but there is extensive detail about removing the adhesions. What modifier would I use if I appeal this procedure? Thanks for your replies!