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Tricare denial for 20985

  1. #1
    Question Tricare denial for 20985
    Medical Coding Books
    I'm new to Ortho coding and our insurance reimburser just brought me a denial from Tricare for code 20985. I had coded 27447 w/20985 (they paid 27447). Reason code was:
    032: This service is non-coverd. Network providers may not charge beneficiaries for the services. I've been asked if there is anything else I need such as modifiers and I said I didn't think so but since the surgeon does these a lot I was going to check with you guys My question is does anyone know if this is a procedure that is routinely not paid by most insurance or only certain carriers and is there anything I can submit for an appeal or modifiers that need to be added?
    Last edited by pnwcoder; 10-06-2011 at 11:37 AM.

  2. #2
    Hartford, CT
    20985 is computer assisted surgical navigation. There are many insurance companies that don't pay for this (or robot assisted either), many consider it experimental. Your best bet is to check each company's policy for this particular code, you may be surprised and find one or two that do pay.

  3. #3
    That's what I thought but didn't want to assume. Thanks so much for answering.

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