Wiki Knee manip/under anesth denied

[bethebest7]

I am looking for help with this scenario:
My doctor performed a knee manipulation under anesthesia (27570) for Arthrofibrosis of the knee. He used the DX 715.16. The claim was denied by UH for "unproven for the dianosis billed and is not a covered expense. There must be scientific evidence submitted.....that demonstrates the safety and effectiveness of this service....."

Any suggestions?

 

[nyyankees]

I am looking for help with this scenario:
My doctor performed a knee manipulation under anesthesia (27570) for Arthrofibrosis of the knee. He used the DX 715.16. The claim was denied by UH for "unproven for the dianosis billed and is not a covered expense. There must be scientific evidence submitted.....that demonstrates the safety and effectiveness of this service....."

Any suggestions?

Did you check the insurance co's website to see what their policy is on this code? I would first start there.

 

[lisaestelle]

Try Dx code 718.56 which is the correct code for Arthrofibrosis of the knee. This should work 715.16 is for osteoarthritis

 

[bethebest7]

thanks

Made some adjustments and also sent them a copy of the payors policy. Thanks for the help!