February 24, 2022

Question:
We precertified and billed a nasal fracture CPT code. The payor requested the operative note which we sent. The payor then denied the procedure and said we didn’t bill the right code. I don’t understand.

Answer:
After reading the operative note you sent, I understand the denial. The Indications said the patient had a “history of nasal fracture” and did not say the fracture was acute. The surgeon also had to do osteotomies to mobilize the nasal bones because the fracture had healed. Therefore, this procedure is considered a rhinoplasty and not a nasal fracture repair.

*This response is based on the best information available as of 02/24/22.