My provider performed a procedure (CPT code 27170) and Tricare is denying the claim because they state this is an inpatient only procedure. Please look at the Description of the Procedure and explain why this was denied.
The patient was taken to the operating room and general anesthesia was induced in the usual successful manner. He was then placed on the fracture table after the left lower extremity was identified through a timeout noting it was the correct operative extremity. The left lower extremity was prepped and draped in the usual sterile fashion. Incisions were performed through the previous made incisions. The first was proximal to the greater trochanter. The Stryker Gammon nail cap was removed with the screwdriver. next we placed in the set screw and released it iwth 2-3 turns.We then placed the intramedullary guide rod distraction. Next, we made an incision at the cephalomedullary femoral head screw and used a guidewire to insert it up into the previously placed screw. We attached the screw removal device and then using C-arm fluoroscopy for both of these, we moved the C-arm fluoroscopy to the knee and used a screwdriver throughthe poke-hole incision laterally to remove the two lateral locking distal screws. These were removed wothout incident. Then we went back up to the proximal hip and removed the femoral neck screw, taking care not to strip the bolts. We then back flapped the cephalomedullary nail out and confirmed that all hardware had been removed with the C-arm fluoroscopy. At this point, we used a cannulated system for the Osteoset bone graft and inserted it up into the femoral head region and back filled to the femoral head and femoral neck with 15 ml of Osteoset. All incisions were copiously irrigated with bulb syringe and closed with 0 Vicryl, 2-0 Vicryl and polypropylene suture for skin. Dry sterile guaze dressings were applied to the incisions. The patient was reversed from anesthesia ans sent to the recovery room in stable condition. There were no complications.
Let me know what you think and Thanks for your help.