Wiki Need help with denial

[umhamza123@hotmail.com]

Hi,
The provider is billing for procedure listed below the following codes: 30465, 30140, 30520, 21210. The insurance paid all codes except CPT 21210, stating the op report does not support the code, and that a more appropriate code should be used. Any ideas on what code will better describe the procedure?
Thank you

 

[jackjones62]

Good afternoon, CPT 21210 is a bone graft that is separately harvested to repair a defect, that repair includes screws, plates or wires, your surgeon did not "harvest" this bone graft, bone and cartilage were removed during the Septoplasty and Nasal Valve procedure in order to improve the anatomical defect, repurposing bone/tissue from a procedure does not constitute "harvesting" for a graft. If your surgeon harvested ear cartilage for the spreader grafts then you can charge for that graft, you cannot charge for the use of autogenous material that is being repurposed during the same procedure.

Hope this helps!

Jennifer
Coding Analyst