We are having trouble having a claim accepted (private insurance) for a patient who had both breasts and both ovaries/tubes removed due to a family history of breast and ovarian cancer, and she is BRCA+. The claim has been denied twice. Insurance is not accepting diagnosis codes. It was first submitted with: V84.01, V84.02, then secondly with V16.3, V16.41, V84.01, V84.02. Breasts showed nonproliferative fibrocystic changes and ovaries/tube without pathology.
I suggested changing the codes to: V50.42, V50.41, V84.01, V84.02. Would it help to include the code for fibrocystic breast, 610.1, even though that diagnosis has nothing to do with the reason the surgery was done? It wouldn't do anything for the ovary/tube removal.
Any other suggestions?
I suggested changing the codes to: V50.42, V50.41, V84.01, V84.02. Would it help to include the code for fibrocystic breast, 610.1, even though that diagnosis has nothing to do with the reason the surgery was done? It wouldn't do anything for the ovary/tube removal.
Any other suggestions?
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