Wiki 20610 experimental????

[jennaduncan]

We had a denial of procedure 20610. According to the denial the above listed code is excluded from coverage because it is connected to a service that is considered experimental and there for not covered. This was for the injection of a viscosupplement J7231. They paid for the drug but not the injection. I am doing an appeal and just need some help getting my wording right.

 

[jmcpolin]

There is no way for the Supartz to get into the joint with out putting a needle into the joint and injecting it in, I have never seen that denial how odd, who is the insurance?

 

[mitchellde]

What is the dx code or codes you are using? I have seen this denial with this code and it is usually the dx code.

 

[jdemar]

I agree with the problem being the dx, Medicare does not pay for pain dx, but for arthritis dx. So it depends on the insr. co.

 

[melzinser]

carrier edit "glitch"

We have been told in Ohio that TWO carriers had a "glitch" when NCCI edits were updated 2nd quarter 2012. We have perfect claims (medical necessity, pre-auths, correct dx, followed the clinical guideline to the letter) and getting the denial you describe. Couldn't reason with provider reps so we are doing a mass appeal with cover letters, copy of carrier policy and hard copy claims. We are now seeing correct payments. No word on when either of these two carriers will correct the "glitch."

 

[jennaduncan]

The dx was OA of hte Knee, I am going to appeal this but i just need help with how to word the appeal. Thanks

 

[kelsey2]

20610

I too had many denials for the 20610. The insurance carrier was denying due to it being a surgical procedure? It turned out to be a "glitch" in the system on the part of the insurance carrier. By all means, call them or appeal....