It sounds to me that you are right......
But I wanted to clairify that the FNP is performing the debridement completely by herself not as part of another procedure that is performed by the physician at the same setting or on the same DOS. In this case you would append modifier -AS as the service is rendered as a part of another procedure. But I'm sure you know this already.
You appealed on the correct basis scope of practice for the FNP.... Did you send in her state licenseur, state law pertaining to NPP services in you state and the signed contract between her and the physician?
Sounds like you'll have to deal with the plan administrator/provider relations.....
I dealt with something similar and despite our efforts payment remainded denied due to the insurance policy!!
Sabine Colton, CPC , CCC
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