Author Topic: Medicare Denial for 2nd TURP - 368 days apart  (Read 4454 times)

Dianac

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Medicare Denial for 2nd TURP - 368 days apart
« on: August 29, 2012, 04:20:12 PM »
Hi. This is the first time I have asked a question here, but this one has me puzzled and I have about 1 week before this claim is a year old.
Our patient had a TURP (52601) done 8/6/10 dx 185 and another on 9/9/11 same code and dx. Medicare continually denies this 2nd TURP saying the patient is responsible. I have tried modifiers 78 and 58 as well without success. Any ideas? Medicare will not give hints.
Thanks.
Diana.

p.s. thanks..sometimes simple is complicated

supertaz93

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Re: Medicare Denial for 2nd TURP - 368 days apart
« Reply #1 on: August 30, 2012, 06:54:30 AM »
From what I see, 52601 is a once in a lifetime procedure and you will need to use a different code.  http://codingnews.inhealthcare.com/specialty-coding/urology-coding-turp-urodynamics-and-stone-removal/

Dianac

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Re: Medicare Denial for 2nd TURP - 368 days apart
« Reply #2 on: September 03, 2012, 12:19:31 AM »
Thank You!! I believe this is what I needed.