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Knee manip/under anesth denied

  1. #1
    Location
    Pensacola, Florida
    Posts
    13
    Smile Knee manip/under anesth denied
    Medical Coding Books
    I am looking for help with this scenario:
    My doctor performed a knee manipulation under anesthesia (27570) for Arthrofibrosis of the knee. He used the DX 715.16. The claim was denied by UH for "unproven for the dianosis billed and is not a covered expense. There must be scientific evidence submitted.....that demonstrates the safety and effectiveness of this service....."

    Any suggestions?

  2. #2
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Quote Originally Posted by bethebest7 View Post
    I am looking for help with this scenario:
    My doctor performed a knee manipulation under anesthesia (27570) for Arthrofibrosis of the knee. He used the DX 715.16. The claim was denied by UH for "unproven for the dianosis billed and is not a covered expense. There must be scientific evidence submitted.....that demonstrates the safety and effectiveness of this service....."

    Any suggestions?
    Did you check the insurance co's website to see what their policy is on this code? I would first start there.

  3. Default
    Try Dx code 718.56 which is the correct code for Arthrofibrosis of the knee. This should work 715.16 is for osteoarthritis

  4. #4
    Location
    Pensacola, Florida
    Posts
    13
    Default thanks
    Made some adjustments and also sent them a copy of the payors policy. Thanks for the help!

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