I'm a new CPC working on a CDI team. We are working with a denial from Craniofacial Clinic where the provider is seeing a young patient for NoseAlign management in preparation for eventual cleft lip repair. They were billing an E/M each visit and documenting that they were removing the NoseAlign device and the tape, checking the area, and then either re-inserting/taping the same size or inserting the next size up of the NoseAlign device.
On the Final outpatient office visit before the patient had the cleft palate repair, the provider billed 21087 (impression and custom preparation; nasal prosthesis). The documentation at the visit did not state impressions were made; it appeared to document the same as prior visits where the provider removed lip tape/NoseAlign device and replaced with same size NoseAlign device. We feel the documentation does not justify billing 21087; it is just such a large $$$ I am hesitant to change to E/M without fully understanding use of 21087 or NoseAlign device sizing/management.
Does anyone have experience coding these kinds of visits where the provider is seeing a patient for repeat visits for NoseAlign or NAM management prior to a cleft palate repair and would care to share insight?
TY in advance.
On the Final outpatient office visit before the patient had the cleft palate repair, the provider billed 21087 (impression and custom preparation; nasal prosthesis). The documentation at the visit did not state impressions were made; it appeared to document the same as prior visits where the provider removed lip tape/NoseAlign device and replaced with same size NoseAlign device. We feel the documentation does not justify billing 21087; it is just such a large $$$ I am hesitant to change to E/M without fully understanding use of 21087 or NoseAlign device sizing/management.
Does anyone have experience coding these kinds of visits where the provider is seeing a patient for repeat visits for NoseAlign or NAM management prior to a cleft palate repair and would care to share insight?
TY in advance.