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Thread: TAH-BSO and bilateral pelvic lymph node dissection

  1. #1
    Join Date
    Apr 2007
    Location
    Kansas City, MO
    Posts
    736

    Default TAH-BSO and bilateral pelvic lymph node dissection

    I am having one of those moments where my brain is locked.

    I just received a OP report with a denial from the insurance company. The codes billed out by the coder were 58150-62 and 38770-5062, they denied 38770-5062 as being inclusive to 58150. Nothing I can find in CCI, CPT or ACOG bundles this. Am I missing something?

    The surgery was done for adenocarcinoma of the endometrium. The procedure included at TAH-BSO and they removed the obturator and iliac lymph nodes bilaterally. No omenectomy, or partial vaginectomy was performed. There was no evidence of extrauterine disease present.
    Angela Jordan, CPC
    AAPC of Kansas City, Region 5 - Southwest
    Medical Revenue $olutions
    Managing Consultant

    angela@medicalrevenuesolutions.com

  2. #2
    Join Date
    Apr 2007
    Location
    Idaho
    Posts
    30

    Default

    Hello, sometimes individual insurance companies have there own edits. So if I was you I would look on the insurance company website to see if they have there own edits. If they do then you might be able to appeal there decision. I know in the state I live in you can appeal an edit denial and sometimes you can get it paid.

    Thanks

    Rebecca

  3. #3

    Default

    if your report reads bilateral removal of lymphs? sometimes the provider report bilateral but in the context of the report they are not removed bilateraly, i notice that the sequence of the modifier on 38770 would be 62-50-51

    or would it be best to code 58210 if there is more work involved in the procedure.(radical) it would be best to obtain your provider assistance.
    Last edited by garcia06; 03-29-2008 at 01:11 PM.

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