Wiki 29880 and United HealthCare

[IRISHCODER]

We have recently started having an issue with United HealthCare and some of our meniscectomies. Our physicians will schedule to perform a medial OR lateral meniscectomy on a UHC patient based on exam and MRI report. It has happened a number of times that during surgery they discover a previously undiagnosed tear on the opposite side. In the best interests of the patient, the newly discovered tear is repaired during this surgery, changing the CPT code from 29881 to 29880. Since 29881, done as an outpatient, does not require precertification, but 29880 is considered "unproven and needing authorization", how do other practices handle this situation? Do you precert all meniscectomies as a 29880 on the chance they become this, or appeal after denial? I'd appreciate any input you may have. Thanks for your help!

 

[YMOLINA61@GMAIL.COM]

29880 and UHC

I called UHC and they explained that 29880 needs auth while 29881 does not. I explained to them that sometimes the lateral tear is discovered during surgery and we have no control over that. The operator informed me that we need to make sure that we get an auth for 29880 and 29881, even if we only see a mmt. Hope this helps!