reneedanielle22
Networker
what is Cigna looking for to pay for CPT code 54405. have a denial and I was thinking because whoever did the claim did not add all of his dx codes to go with 54405?
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Wiki help with claim for CPT 54405??
- Thread starter reneedanielle22
- Start date
mitchellde
True Blue
What codes were used, what is documented, and what does the denial state. You can only use what is documented in the procedure note.
reneedanielle22
Networker
Hi thanks for getting back to me Mitchellde. The Insurance said it wasn't covered. They only put 1 dx code I can't remember the number off hand now that I'm home but it was the one where it's impotence of organic origin. I am thinking maybe the DX code used makes it seem elective because he has a host of problems that wasn't added to the claim. Should I resubmit with the additional dx codes? would that get it approved? I don't have the operative report and there was nothing really on the face sheet.
mitchellde
True Blue
Without the operative report there is no way to determine the appropriate codes. You should never code without the report. It does look elective and non covered with what you have, but that may be the real answer even with the other issues or it may be the incorrect code. You will need an operative report to see.
reneedanielle22
Networker
OK thanks very much!
sande78705
Networker
I have found that many insurance companies will not pay for impotence and therefore the treatment is not covered, but it does depend upon the reason for the impotence. That is why the dx code is important. A patient with diabetes may develop impotence and the insurance company might pay. This could be a coverage issue with the patient's policy.
reneedanielle22
Networker
Thanks Sande78705! The operative report didn't give me much insight. I ended up attaching the Patients applicable medical records along with his current DX codes and resubmitted to the Ins. I'll check the status of this claim in a few days or so.