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58862

  1. #1
    Location
    Buckhannon, WV
    Posts
    10
    Wink 58862
    Medical Coding Books
    Does anyone know if there is an age limitation on this code? One of our physicians performed this procedure on an 11 year old and their insurance carrier is telling me that this code has an age edit of 12-99 years old. All help would be greatly appreciated.

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I don't see 58862 in CPT...
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    Bradenton, Fl
    Posts
    82
    Default
    I don't either...I was looking too!
    Angie Olson, CPC

  4. #4
    Location
    Buckhannon, WV
    Posts
    10
    Default
    sorry try 58662, it has been a long Monday!! It was a laparoscopy with fulgration or excision of lesion of ovary.

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Well, I started with the CPT book, there isn't any limitation there (such as with codes 54160/54161 just for example-because it states the age requirements)... I've checked so many online sites - nothing - no age limit.

    I'd appeal the denial - obviously this procedure CAN be done on patients under 12 years of age - it's probably not done very often, but that's not to say it can't be.

    Maybe someone else will find something - but I researched and found, no age limit.
    Donna, CPC, CPC-H

  6. #6
    Location
    Bradenton, Fl
    Posts
    82
    Default
    I also have searched everywhere! I agree with Donna's statement....plus what would be the difference between a 11 year old to a 12 year old?? I would appeal, that doesn't make sense for that particular code. Sorry I couldn't find something concrete! Anyone else??
    Angie Olson, CPC

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Appeal w/ Op Note
    I'd appeal with the op note attached. I work for a pediatric surgery specialty and we occasionally get denials like this. It's a computer programming thing probably .. insurance carrier has certain "edits" pre-programmed to rule-out miscoding. A letter appeal w/ op note attached will force a person to look at this and see that it is correctly coded. It would help, also, if you have a pre-auth for this CPT.

    F Tessa Bartels, CPC,CPC-E/M

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