solocoder
Expert
Could I get some opinions, please?
14040 was denied, and denied on appeal by Humana (medicare) for this procedure as not supported by documentation. They claim the documentation only supports "complex multi-layered closure". Can anyone tell me why they are denying this? I only have a few more days to try filing a grievance with Humana. Or am I wasting my time? Should I just "correct" the code to what they are asking for?
An incision was made on the plantar-lateral aspect of the heel to create a flap which was then advanced medially, and it was trimmed to fit. Tourniquet was then released with a total tourniquet time of 28 minutes. All the bleeders are ligated. The area is flushed with sterile saline solution and all the bleeders are ligated. The area was packed with antibiotic impregnated Osteoset resorbable beads.
The plantar skin flap that has been created was rotated medially and the subcutaneous tissues were reapproximated using #3-0 Polysorb suture. #3-0 Nylon was used to reapproximate the skin ends in horizontal mattress and simple interrupted fashion.
14040 was denied, and denied on appeal by Humana (medicare) for this procedure as not supported by documentation. They claim the documentation only supports "complex multi-layered closure". Can anyone tell me why they are denying this? I only have a few more days to try filing a grievance with Humana. Or am I wasting my time? Should I just "correct" the code to what they are asking for?
An incision was made on the plantar-lateral aspect of the heel to create a flap which was then advanced medially, and it was trimmed to fit. Tourniquet was then released with a total tourniquet time of 28 minutes. All the bleeders are ligated. The area is flushed with sterile saline solution and all the bleeders are ligated. The area was packed with antibiotic impregnated Osteoset resorbable beads.
The plantar skin flap that has been created was rotated medially and the subcutaneous tissues were reapproximated using #3-0 Polysorb suture. #3-0 Nylon was used to reapproximate the skin ends in horizontal mattress and simple interrupted fashion.