Phenol Rhizotomies and United Healthcare of Georgia

[MHorns]

I work for a pain clinic that bills for codes 64622, 64623, 64626 and 64627 for the phenol rhizotomy. We are being denied by UHC of Ga stating our medical records do not support the procedures billed. Our notes do support the procedures we are billing for but when we called UHC and spoke to our provider representative we were informed we had to include the temperature of the needle and time spent when we send the records. We use phenol which is not heat and therefore do not feel this is correct. Can someone help me to understand what they really want.

[psu_213, BSN, RN]

I am not family with the procedure, the insurance company, or their requirements to get you paid.

My guess as to what they want: to avoid paying for a procedure that will help people and (hopefully) relieve their pain. (Just my opinion on the subject)

[morte, LPN, LVN]

had to deal with them over a dental procedure once.....a friend of mine who was working for an insurance co. at the time told me that they deny the claim to delay the payment....I called them up and threatened them, told them i knew exactly what they were doing, and the ins. commision was my next call.

[Esme12, ASN, BSN, RN]

We are nurses about nursing....I am not sure we can help you......I am sure it is just another way to delay reimbursement. Nurses have very little to do with billing or billing codes there are specialists in coding that complete this task..interesting

[suern2b]

there are many nurses who are also coders.. we are auditors.. generally you would be better off looking on the coding sites like aapc or similar.. but since I am here.. UHC is notorious for delaying via denial.. take it to a second level appeal, photocopy the notes, clearly underline (not highlight everything is scanned) the sections that support the codes, copy the cpt book that describes the codes you use, and if you really want to be done with this the first time (well second) have the provider add a letter explaining what was done. Follow the instructions for a second level appeal for mailing. Copy your provider rep, who apparently doesn't have a clue, those codes are destruction by neurolytic agent, so that includes chemical agent. If you have any books that more clearly define the codes like expert coding books send those. spell it out in crayon for these guys. If they keep it going and deny again ask them for a copy of the specific UHC policy that allows them to deny this code and what coding rules they use to deny this code. Hope that helps :)

[Esme12, ASN, BSN, RN]

there are many nurses who are also coders.. we are auditors.. generally you would be better off looking on the coding sites like aapc or similar.. but since I am here.. UHC is notorious for delaying via denial.. take it to a second level appeal, photocopy the notes, clearly underline (not highlight everything is scanned) the sections that support the codes, copy the cpt book that describes the codes you use, and if you really want to be done with this the first time (well second) have the provider add a letter explaining what was done. Follow the instructions for a second level appeal for mailing. Copy your provider rep, who apparently doesn't have a clue, those codes are destruction by neurolytic agent, so that includes chemical agent. If you have any books that more clearly define the codes like expert coding books send those. spell it out in crayon for these guys. If they keep it going and deny again ask them for a copy of the specific UHC policy that allows them to deny this code and what coding rules they use to deny this code. Hope that helps :)

It was a thoughtless comment...it really wasn't what I meant to say but it came out that way......I stand, deservedly, corrected.......

[suern2b]

no worries :) Just letting people know there are other avenues to use these nursing licenses and degrees especially in this awful job market..