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PLAIDMAN

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My doc did arthroscopic thermal chondroplasty of knee, I used unlisted 29999.

It is being denied as experimental. I am having increased difficulty getting unlisted codes paid as of 2011 all saying "experimental"

Has anyone had this problem? How did you resolve it?

Would appreciated any help!
 
Who is the payer?

Who is the payer that is denying all your unlisted codes? How many have you used? Are you submitting documentation of the procedure with the claim?

Consider if you are utilizing the proper CPT-4 code and request from the payer further instructions for the procedures. Short of that, you may need to inform your patients up front about their payer's policy of denying some services as "experimental" and collect funds up front.
 
This particular payor is Humana.....also have had UHC deny for different proced.

Yes I did send documentation and they reviewed it and made their determination. I think we may end up eating this one upon further research we pre-auth meniscectomy, when he went in he did not find tear so he just waved the wand around and done.

So, I thank you but I think this one is kind-of our fault
 
In the future good luck with unlisted codes, but I know that usually if we have an unlisted, we get predeterminations from the insurance company up front, especially UHC because we have big time trouble with them. Predeterminations are almost better than auths because they review all the info like they would for an auth and tell you what they will pay.
 
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