nauger
Networker
Our Orthopedic surgeon recently received an EXL audit on behalf of Medicare Plus Blue for a Manipulation of knee joint under general anesthesia (CPT 27570). Their audit said "After reviewing the medical documentation CPT 27570 was denied based on CPT guidelines, the submitted documentation does not support CPT 27570. Per the documentation, the patient was administered IV Sedation, which is not considered anesthesia."
Per the Reviewer - CPT guidelines state code 27570 requires general anesthesia and IV sedation does not meet those criteria.
We have located many policies (Aetna, UHC, etc.) that state IV Sedation meets the criteria for this code and they will pay with IV sedation. However, Medicare Plus Blue is not considering IV sedation appropriate.
Has anyone experienced this or does anyone have any knowledge or resources that we could use to get around this denial?
Per the Reviewer - CPT guidelines state code 27570 requires general anesthesia and IV sedation does not meet those criteria.
We have located many policies (Aetna, UHC, etc.) that state IV Sedation meets the criteria for this code and they will pay with IV sedation. However, Medicare Plus Blue is not considering IV sedation appropriate.
Has anyone experienced this or does anyone have any knowledge or resources that we could use to get around this denial?
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