Coding Alert: Two New Coding Resources Available to Support Appeals of Inappropriate Denials

For orthopaedic surgeons who are experiencing inappropriate denials of certain Current Procedural Terminology (CPT) codes, AAOS is working to support its members in their appeals to payers. AAOS has developed appeal letter templates and gathered a range of informational resources, such as FAQs and AAOS Complete Global Service Data content.

In addition to the current resources to support appeals for total knee arthroplasty denials and shoulder arthroscopy denials, there are now two new appeal resources available to further support members in obtaining appropriate reimbursement for procedures and services rendered.

Drug-delivery device appeal letter template
This appeal letter template may be used to appeal inappropriate denials for drug-delivery devices—CPT codes 27000 to 27005—reported in conjunction with other procedures that may be performed at the same time. The letter offers a framework to support appeals for denied procedures and may be altered to fit the specific situation.

Modifier 25 with evaluation and management (E/M) resource
The modifier 25 resource is a comprehensive chart on proper reporting of CPT modifier 25 with E/M codes. The chart includes CPT and Centers for Medicare & Medicaid Services guidelines. The resource will provide strategic knowledge on reporting of E/M services and support efforts in appeals for inappropriate denials.

There are also two downloadable template appeal letters that may be altered to fit the user’s specific situation. One letter may be used for inappropriate denials of E/M services appended with modifier 25 when reported in conjunction with other E/M codes; the other letter may be used for inappropriate denials of E/M services appended with modifier 25 when reported with other minor procedure codes on the same date of service.

To access these coding resources, visit the coding and reimbursement webpage.