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Posted By Susan on 02-08-2006, 18:43:00 in Ob-Gyn
Does anyone know if code 58545 for lsc myomectomy requires an assist? My doctor says yes, but Aetna says no. Even on appeal they are saying an assitant was not necessary. Don't know where to go from here to get this paid. Any help appreciated.
Comments (5)
Posted By Arlene on 02-09-2006, 16:40:00
Good idea thanks!

Posted By Cat on 02-09-2006, 03:27:00
I've had this problem also. If you have the AGOG guideline book, that helps, but, didn't get me anywhere in this case. I finally got paid by getting the hospital guidelines for assistant required from the hospital in question. Try that. Sometimes it works, sometimes not.
Posted By Susan on 02-09-2006, 00:42:00
I guess we'll just keep appealing. thanks
Posted By jan on 02-08-2006, 22:14:00
In a message dated 2/8/2006 3:09:16 PM Central Standard Time,
swiedner7@verizon.net writes:

> Does anyone know if code 58545 for lsc myomectomy requires an assist? My
> doctor says yes, but Aetna says no. Even on appeal they are saying an assitant
> was not necessary. Don't know where to go from here to get this paid. Any
> help appreciated.
>

Medicare allows an assist for 58545.

Jan Rasmussen CPC, ACS-GI, ACS-OB
Professional Coding Solutions
janrhcr@aol.com
Posted By Arlene on 02-08-2006, 21:15:00
That code allows an assist according to medicare guidelines.  There is also a decision from the ACOG Committee on OB/GYN practice from August 2000 that states a surgeon should be allowed to decide when an assist is needed in laparoscopic surgeries. I use those two factors when appealing such a decision.

With Aetna it is much more difficult. We had the same surgery assist denied by Aetna and even after appealing with all this information they have continued to uphold the denial. We have also taken it to ACOG and to the provider rep at Aetna with no further resolution to the problem. But the more people who complain and appeal...then eventually perhaps they will see the light and change their policy.

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