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Discontinued Essure reimbursement

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debbied58:
I am looking for a sample letter or advice to explain to an insurance company about a failed Essure procedure.  The device is ver'y expensive and I thought that I would try to bill it with a 53 modifier but what else can I do to recoup the cost of the device?  The patients's tubes were not able to be seen so the procedure was discontinued.

Michele:
Hi,

   I would recommend billing out the code for the essure procedure with the 53 modifier, like you said.  That modifier describes exactly what you are describing.    I don't think it is necessary to include a letter, the modifier should be enough.

Michele

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