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30600 (Oroantral fistula closure) was denied by medical because dental services are not processed under patients plan. Initially the medical insurance Paid $961.36 but reviewed the claim and now almost 4 months later is asking for a refund of the $961.36. I used diagnosis codes of J32.0 and G50.1. I called the medical insurance and they said I would need to file an appeal to prove medical necessity and it could be reversed. Im new to billing medical and we are an Oral Surgery office. Any help would be greatly appreciated.
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
30600 - Repair fistula; oronasal
J32.0 - Chronic maxillary sinusitis
G50.1 - Atypical facial pain
For the appeal, you will want to be sure to include your SOAP notes/clinical notes that shows the medical necessity. Patient medical history, your doctor's exam/procedure notes, the diagnosis and treatment plan information should all be included.
You may also consider to include in your appeal using the following diagnosis code to represent the oronasal fistula:
M25.18 - Fistula, other specified site
Hope this helps!
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