Urology Coding Alert

Use this template to show the payer why you deserve every cent of reimbursement

You followed your carrier's TURP coding guidelines to the letter, and you double-checked your coding against our flow chart, but your payer still denied your claim.
 
Before you accept the denied reimbursement as law, consider appealing the claim. We've laid out this template for you to adapt to your practice's specific circumstances when you face denials.

June 1, 2006

Smith Insurance Co.
100 Elm Street
Anytown, USA 10000

Re: Denial for Transurethral Resection of the Prostate

Insured: Raymond Johnson
Patient: Sally Johnson
ID #: 12345-6789
Date of service: March 1, 2006
Claim #: MR600450

Dear (Medical Director's Name):

This letter is to appeal your denial of payment for the attached claim.
 
You denied our claim for transurethral resection of the prostate (code 52630) by erroneously stating that this TURP CPT code is a "once-in-a-lifetime procedure." However, although we acknowledge that code 52601 is a "once-in-a-lifetime procedure," we specifically billed 52630 for this patient's procedure. Because the patient's previous TURP occurred over a year ago, we understand that 52630 is the correct code for the service that we performed on March 1, 2006.
 
We have confirmed this code choice with your carrier guidelines, and consulted CPT Coding Guidelines as provided by the American Medical Association.
 
Attached you will find a copy of my operative report, indicating that I performed the TURP three years after the patient's previous TURP. Based on this information, we expect to receive appropriate payment for our claim.
 
If you have any questions or would like to discuss this further, please call me at (555) 555-1234.
 
Thank you for your immediate attention to this matter. I will look for your reply within 14 days.

Sincerely,
John Doe, M.D.