Code 44312

Does anyone have an suggestions on finding guidelines related to the above referenced code? Filed as done in the clinic and insurance payer is asking for documentation from specialty society stating that this procedure can be done in a physician's office.

44312

This procedure is not on the CMS Inpatient Only list so it does not warrant hospitalization. The description sounds like it could be done in the office but I am no surgeon- "release of superficial scar" sounds pretty inocuous. Did you send the operative note?

44312

Yes an op note was sent, but still denied.

Re: 44312

Well, it does not have a different allowable for office vs. facility, which makes me think it is not typically done in an office setting. It has an RVU of 14.84 and a 90-day global period. This also tells me this code is not meant to be used for something simple they may be doing in the office.

In addition, if you take a look at the description of this code in the Coder's Desk Reference, it involves possiblely pulling out more ileum and reapproximating after the contricting scar tissue is released. That sounds like something done in an OR.

Do you have an example procedure note? Perhaps you should be looking at a different code, maybe something in the integumentary system?

thanks!
:) Erica