Linda Posted Tue 07th of March, 2017 15:19:39 PM
CPT code 29881 has denied as experimental or investigational. The other CPT code on the claim was 29876.
ICD 10 code used were M23.211, M17.11, and M67.861.
I know that the denial of investigation has to do with the diagnosis but I can find one that Aetna will accept. Any suggestions would be great.
SuperCoder Answered Wed 08th of March, 2017 04:20:15 AM
As per the Aetna policy, it considers arthroscopic partial meniscectomy medically necessary for traumatic meniscal tears. Aetna considers arthroscopic partial meniscectomy experimental and investigational for degenerative meniscal tears.
As per your scenario, you coded ICD 10 as M23.211, M17.11, and M67.861 (all the three diagnoses code are related to the degenerative changes). In order to get it reimbursed, you need to have an ICD 10 from S83.2 series. Also, your medical records should reflect that the procedure was done for traumatic meniscal tear.
Check with your respective payer for any further clarification.