ࡱ> 463 !bjbj 4"ee!ll :DDDD3|Y@$2 ~=33=DDR///"DD////Dq /h0/ j / //==/ l : Attention: Please also report the payers denial reason for image guidance through the Practice Management Member Inquiry Form:  HYPERLINK "http://www.entnet.org/content/practice-management-tool" www.entnet.org/content/practice-management-tool Drafted February 2011 [Date] [Insurer Name] [Insurer Address] Re: Patient: [Name] Policy Number: Group Number: Claim Number: Date of Service: Dear [Medical Director]: Please consider this letter a formal request for reconsideration of a denial received for a stereotactic computer assisted navigation (SCAN) procedure (image guidance) performed on [Patients Name] on [Date of Service] by [Name of Physician]. The claim for the SCAN procedure was billed with CPT code +61782 - cranial, extradural (List separately in addition to code for primary procedure). Although CPT code +61782 is a new CPT code and became effective on January 1, 2011, it describes an existing procedure that [Insurer Name] previously covered and reimbursed. The former code for the SCAN procedure was CPT code +61795 - Stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure); it was deleted because the CPT Editorial Panel split it into three separate add-on codes (+61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural - , +61782 - Stereotactic computer-assisted (navigational) procedure; cranial, extradural and +61783 - Stereotactic computer-assisted (navigational) procedure; spinal) to differentiate distinct anatomic regions. Of course, one can no longer report a service with a deleted code, but CPT code +61782 is the same procedure that was previously covered by +61795. Therefore, your denial of +61782 as experimental and/or investigational or otherwise considered non-reimbursable is totally illogical. The full allowable amount should be paid for CPT code +61782 because it is an add-on procedure code, and its Medicare fee work relative value already accounts for the procedure never being performed alone. As you may be aware, SCAN provides the surgeon with 3D real-time positioning within the nasal cavity and paranasal sinuses, allowing him/her to appropriately remove diseased tissue and avoid damage to the orbital, other extra-cranial and/or intra-cranial areas. This is particularly useful in patients who have experienced a loss of surgical landmarks and barriers due to previous surgery, sinonasal polyposis, neoplasms, or severe infections/inflammatory processes. The purpose of using stereotactic computer-assisted navigation in sinus surgery is to maximize accuracy and safety of the surgical procedure. I am enclosing the previously submitted claim, the Explanation of Benefits, operative notes, and the һϲ Head and Neck Surgerys policy statement, Intra-Operative Use of Computer Aided Surgery and Coding for Stereotactic Computer Assisted Navigation. Please reprocess this claim for the payment of CPT code +61782. If you require additional information, please contact me at [Phone number]. Thank you for your prompt action. Sincerely, [Physician Name, MD] Enclosures: [insert number of enclosures] cc: [Patients Name] Note: Please copy and paste the following links into your browser to access. Link to Intra-Operative Use of Computer Aided Surgery Policy statement:  HYPERLINK "http://www.entnet.org/content/intra-operative-use-computer-aided-surgery" www.entnet.org/content/intra-operative-use-computer-aided-surgery Link to Coding for Stereotactic Computer Assisted Navigation:  HYPERLINK "http://www.entnet.org/content/cpt-ent-stereotactic-computer-assisted-navigation" http://www.entnet.org/content/cpt-ent-stereotactic-computer-assisted-navigation "'8LX      о߄reXMB7h Yh:OJQJheNh:OJQJheNhaOJQJh:OJQJmHnHuhaOJQJmHnHu"hah{5OJQJmHnHuh{5OJQJmHnHuhbhzu\hb0JOJQJhzu\hbOJQJjhzu\hbOJQJU"hzu\hb5OJQJmHnHuhb5OJQJmHnHuha5OJQJmHnHu"haha5OJQJmHnHu    ) ; < = e b c cd$a$gdeN`gdeNgdeN ` c P X EKwd|ڳڧvjj_heNh:OJQJheNh:OJQJ\h3h:OJQJ\h Yh:6OJQJ\h:`h:6OJQJ\h:OJQJ\h Yh:OJQJ\h Yh:hOJQJh Yh YOJQJh Yh:56OJQJh Yh:OJQJh Yh:6OJQJh Yh:0J6OJQJ stJK01!gdeN$a$gdeNJKS,-./19mpq} !˼˰s˰h]hzu\h YOJQJh) h) OJQJh Yh Y56OJQJh Yh YOJQJh:`hch) 0JOJQJhzu\h) OJQJh) OJQJjh) OJQJUh Yh Y56OJQJ\h Yh Y5OJQJ h:`h:`hzu\h:`5OJQJhzu\h:`OJQJhzu\h:OJQJ21h:pJ'/ =!"#$% j  666666666666666666666666666666666666666666 6666666666 66666666666 6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH L`L eNNormal$CJOJPJQJ_HaJmH sH tH DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List DoD eN0cptdesc-indented OJQJ^J:U`: eN0 Hyperlink>*B*^JphH@H eN0 Balloon TextCJOJQJ^JaJNo!N eN0Balloon Text CharCJOJQJ^JaJF'`1F g~0Comment Reference CJ^JaJ<@B< g~0 Comment TextCJaJNoQN 0Comment Text CharCJOJQJ^JaJ@j@AB@ g~0Comment Subject5\ZoqZ 0Comment Subject Char5CJOJQJ\^JaJFV`F <0FollowedHyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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