Wiki Is UHC denying for 60-day Crossover Dx, like BCBS?

[admin@k2derm.com]

Hi - I have a UHC denial for an OV 99212 (included in payment...already adjudicated) with an excision/repair 11602/12032 - all different dx. Another remark is about Global period - previous procedure (17000) was about two months prior, so no. Only thing I can get to is that UHC is now using the BCBS argument about cross-over dx codes with OV within 60 days with procedures... the primary dx is same as from two months ago. Anyone have any thoughts on this one? Thanks!

 

[csperoni]

Ultimately, the payors can set their own policies regarding items like this. You would have to refer to their policy. If their policy is clearly "We won't pay for this" regardless of whether it follows coding guidelines, you don't really have an option. Feel free to formally express your displeasure with their policy, but don't expect it to change.
Hopefully someone with specific derm experience can weigh in if they are experiencing the same.

 

[admin@k2derm.com]

Ultimately, the payors can set their own policies regarding items like this. You would have to refer to their policy. If their policy is clearly "We won't pay for this" regardless of whether it follows coding guidelines, you don't really have an option. Feel free to formally express your displeasure with their policy, but don't expect it to change.
Hopefully someone with specific derm experience can weigh in if they are experiencing the same.

I appreciate your thoughts. Thanks