SheFergie08
Guest
An expanded, endoscopic, endonasal resectioning of a 3 cm meningioma in the tuberculum sella region was performed by our Neurosurgeon with the transnasal approach being done by an ENT acting as co-surgeon in April of this year. There is not a CPT code that accurately describes this procedure; because of this our provider reported 64999. Notation was made that the unlisted procedure being reported was most comparable to CPT codes 61583 and 61601. However, 61583 utilizes a craniofacial approach as opposed to the endoscopic endonasal approach taken in this case. Once the timeout had been performed, the ENT began the exposure. Upon identification of the dura the case was then handed over to our Neurosurgeon to perform the resectioning. I have attached both surgeon's operative report for review, as it would be to much to try and summarize the work justifiably. Our provider reported 64999 and the ENT reported 31299. To date, we have not been successful in obtaining payment for this case. The denial given states this was a co-surgery and would require both providers to submit the same code with modifier 62 appended. However, due to the reporting of an unlisted code the 62 modifier can not be appended. In this case there is not an accurate CPT code available to report for the approach; prompting both providers to use the unlisted code. It is my understanding that because the other surgeon is an ENT his part should be reported using an unlisted code for his specialty, as we have done for our Neurosurgeon. Our claim was billed to the patient's Medicare Advantage plan reporting 64999 with a PWK attachment detailing reimbursement amount requested and reasoning. This was to include allowable for 61583, 61601, 15750, 20926, and 61781. Multiple procedure discount was taken into consideration and a reimbursement of $5,026.96. As previously stated, we still have not been successful in obtaining reimbursement for any of the services performed. Any suggestions on how we can fix this so claim will process? It seems like everything we have attempted is only being met with another denial. Any help would be greatly appreciated!