Wiki Denial of 58563 dx abnormal uterine bleeding

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OBcoder2017

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I have received a Denial from United Health Care for the 58563 with dx 626.9 (abnormal uterine bleeding) stating that "treatment has not been deemed proven to be effective by the payer". Has anyone else experienced this yet? What should my recourse be in this case? I have reviewed the op note and patient was having irregular heavy painful menses, passing large clots. I would appreciate any feedback, thanks.
 
Changing diagnosis

Have you tried changing your diagnosis? 626.9 is an unspecified code. With irregular and heavy menses, I use 626.2, menometrorrhagia. I have not had any problems billing for a hysteroscopic ablation with this diagnosis.
 
I agree with using diagnosis code 626.2. However we had a similar issue here in Pennsylvania with one of the insurance companies. It turns out that some of their plans denied the procedure without pre-authorization. Have you called to investigate further?
 
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