UHC Denials for 15736

[Tbailer]

I was wondering if anyone has had any experience with UHC consistently denying 15736 for documentation does not support and if so, what might be some best practices for my providers to use in their documentation to stop these denials?

Thanks in advance- Tessa

 

[Orthocoderpgu]

I would request a peer review. I know from first hand experience that most insurance companies hire retired medical professionals to answer their questions and the people reviewing medical information usually don't have the broad experience needed since they review most if not all medical questions. I've seen when doctors push back, that's when insurance companies learn.

 

[Tbailer]

I would request a peer review. I know from first hand experience that most insurance companies hire retired medical professionals to answer their questions and the people reviewing medical information usually don't have the broad experience needed since they review most if not all medical questions. I've seen when doctors push back, that's when insurance companies learn.

Thank you for the advice, in this case documents were reviewed by their Medical Director and I feel that maybe a 52 modifier will be appropriate for reduced services. We don't seem to have this issue with other payers which makes this denial so frustrating. Once again, thank you

 

[Tbailer]

Thank you for the advice, in this case documents were reviewed by their Medical Director and I feel that maybe a 52 modifier will be appropriate for reduced services. We don't seem to have this issue with other payers which makes this denial so frustrating. Once again, thank you

 

[Orthocoderpgu]

Your dealing with UHC. I had a patient severely impaled in the stomach with old dirty wood from an old floor. He was in a small town and would bleed out if he was transported by ground ambulance so he was flown by helicopter to our hospital which had a trauma 1 available. Without skipping a beat UHC denied the services since it was not deemed "an emergency". I feel your pain and am not surprised by what happened to you.

 

[thomas7331]

I was wondering if anyone has had any experience with UHC consistently denying 15736 for documentation does not support and if so, what might be some best practices for my providers to use in their documentation to stop these denials?

Thanks in advance- Tessa

I know from experience that one thing UHC looks for in myocutaneous flap procedures is documentation to support the dissection and preservation of the vascular structures. Per CPT description, this is a part of the procedure that defines this type of flap. If the physician is simply transferring tissue without any mention of work related to the blood vessels that supply the flap, then they will likely argue that the documentation doesn't support the procedure code.

 

[Tbailer]

I know from experience that one thing UHC looks for in myocutaneous flap procedures is documentation to support the dissection and preservation of the vascular structures. Per CPT description, this is a part of the procedure that defines this type of flap. If the physician is simply transferring tissue without any mention of work related to the blood vessels that supply the flap, then they will likely argue that the documentation doesn't support the procedure code.

Thank you Thomas and this is exactly what information had been provided to me on an older case. Now to get the provider to provide better documentation if the service is truly performed