Wiki Question about cpt 20553

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SarahT89

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Good morning!

I work in pain management and I am still pretty new to it, as my specialty is in bariatric surgery and hernia repair. I just got hired and am working through some of the older claim cases and one I am working on had code 20553 denied as experimental/investigative and non covered by BCBS. The physician swears up and down it is not experimental and insurance should pay.

Can someone help me? Thanks
 
It's hard to help much without more information - the denial may be due to the diagnosis that was billed or to the drug that was used for this procedure rather than for the procedure code itself. Procedures can be experimental for certain types of conditions but not for others. Or it could just have been a processor error. Also, BCBS is not a single national company, so the policies will vary depending on which location and plan is processing or paying the claim. I'd recommend either contacting BCBS to get more details about the denial, or reviewing the medical policies on the BCBS website of the plan that covers the patient in question.
 
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