Results 1 to 7 of 7

problem with Unitedhealth care paying

  1. #1
    Angry problem with Unitedhealth care paying
    Medical Coding Books
    I have been billing Unitedhealth care for over 2 yrs for a procedure my doctor performed. He consulted the patient, then took her to surgery for an ruptured appendix. While in the area, he did a drainage of ovarian cyst. I coded this 99254-57
    44960
    58805-59
    Unitedhealth paid for consult and drainage, but state the appy was coded wrong. I have sent this in several times with op report and medical records and they still say wrong coding. The surgical assist, who is employed by doctor, received payment for both procedures w/80 modifier- no questions. But Dr's charges are billed wrong.

    Can anyone HELP- I am getting very upset about this and getting the run around. I have spoke to 8 different people since Aug 2008 along- not telling how many before that time.

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    find out who your provider rep is and go to them.

  3. #3
    Default
    Since this has occurred, I now live in NC and Dr in IL and is retired.
    The rep we had prev- was NO help

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I no longer do appeals and such so I no longer have my contacts, but I do know that UHC has a 2nd Level Tier...I'm sure if you've spoke with 8 people already you have probably already reached that level, but they were always helpful.

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    UHC has done the same thing to us time and time again.If provider relations aren't helpful, you do have other alternatives. I haven't had to do this often but I have filed a grievance with the Insurance Commissioner and payment was eventually collected. Another CPC that I know states that UHC has created their own medical condition:

    Neuro-opticrectosis: The optical and rectal nerves become intertwined and you get a dirty, smelly outlook on life.

    Little humor for a Friday afternoon...

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default CPT says Mod 52
    CPT 2008 professional edition Pg 204, under 44950 (yes, I know, you are billing 44960) there's a parenthetical remark that tells you to use mod 52.

    Or ... UHC may want you to code 44955 as the add-on to the drainage (I know this doesn't make sense because the reason you opened the patient was the ruptured appy and not the ovarian cyst... but I'm trying to think like UHC ... and I'm getting a headache ... Becca ... what's the ICD9 for Neuro-Optirectosis?

    So UHC may prefer to see
    99254-57
    58805
    44960-52,59

    -OR-

    99254-57
    58805
    +44955


    F Tessa Bartels, CPC, CPC-E/M

  7. #7
    Location
    North Carolina
    Posts
    3,126
    Default
    Tessa....

    Too Funny...Like anything else in the world of UHC, it's a guessing game and make believe.

Similar Threads

  1. Replies: 2
    Last Post: 08-13-2013, 01:48 PM
  2. preventave care and problem focused e&m
    By genawaller in forum Billing/Reimbursement
    Replies: 1
    Last Post: 01-06-2012, 02:27 PM
  3. Replies: 2
    Last Post: 02-14-2011, 01:18 PM
  4. Ingenix/UnitedHealth Law Suit
    By jardrey in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 04-30-2008, 10:11 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.