Wiki Any opinions appreciated!

[Bella Cullen]

Can someone tell me if arthroscopic biceps tenolysis (29999) is included in 29823.
If it is not included can you please explain why or send me some documentation on this because I did an appeal twice for this because first they said 29999 is included in 29826, so I sent supporting documentation for this and now they are saying 29999 is included in 29823.
They also said 29819 is included in those two codes also but I found documentation that says it is not.
Please help!
Thank you,
Melissa

 

[BCrandall]

Melissa,

I'd have to bluntly ask them how an unlisted code can be inclusive to anything! Did the debridement include the biceps tendon per the documentation? They may be going for that to deny the claim. Ask for a supervisor and a claim review by a similarly qualified physcian from the insurance company. Wear them down!

 

[Bella Cullen]

Thank you very much for your response. UHC said if they deny after 2 times then that is the final determination, but I think that is bull and I am sending documentation again that I got from the AAOS.
The unlisted code I don't have any solid arguement but the 29819 I do so I'm going to at least try to get that paid.
Thanks again,
Melissa