Wiki 29824 Denials

[hammonds77]

I recently received a denial from Humana, which used Orthonet to review the operative note; they denied 29824 Distal Claviculectomy stating that the procedure wasn't documented per AAOS the note but state that at least 8-10 mm of bone was removed. Has anyone had any problem with this code if the physician didn't actually state this but he said to me that

"That's ridiculous. That's exactly what the procedure is. I can start throwing in some statement about how much bone was removed but, by definition, it's 8-10 mm. So it will be a superfluous and unnecessary step, but, fine. Do I get him to do an addendum to the operative note and appeal with the addendum, or is it a way I can appeal without the addendum? Please advise

 

[roxvaughn]

I had to deal with Orthonet when I worked for Ortho Surgery a lot! They are a pain. That's a staple denial for them. If your note supports the procedure, appeal directrly to Orthonet and circle the part of the op notes where the procedure is indicated. I used to do that and it worked. Also state in your appeal letter, please see page #... paragraph#... for the procedure inforamation... Many many times they are wrong at Orthonet, and they don't seem to be very knowledgeable. Good luck. I used to hate dealing with them.

Roxana Bejinariu, CPC, CPMA