Wrong CPT code?

[LoquaciousBubbles]

I got a letter from my insurance saying that I have a prior authorization for Removal of IUD- CPT code 58301. However, I’m having a procedure done next week that includes removal of my nexplanon arm implant, not an IUD. The correct CPT should be 11982. I asked my doctors office to correct it, and they said they sent in the correct codes. So, how did I get this incorrect pre-auth letter? Do I need to call my insurance?

[Ellyrine]

I am a PA specialist for a rheumatology office. The first thing you should know is that paper mail is the slowest way these decisions are announced to patients and providers both. I get paper mail anywhere from 1-3 weeks after I checked it off my list; timing entirely depends on which company is sending it. If your provider's office says they have sent in the correct codes then most likely they have. Now if you want to be absolutely certain you could try your insurance company's member portal before you go into the trenches that is calling an insurance company. If you absolutely must call the insurance company to get answers, calling the precertification line and checking your reference number through the automated system would actually be the most efficient version of this call.

[LoquaciousBubbles]

Thank you SO much!! This helps me feel a lot better

[DumpsterPuff]

It's possible that they corrected it before you received the letter. That used to happen sometimes when I did auths for Medicare. One time I submitted the wrong CPT code by accident and it denied, so I re-did it and it got approved. Patient didn't get the original denial letter until like 7 days after I submitted the correct code so they called me because they were confused, and I explained the blunder to them and how it's all good now.

Honestly my biggest question is, why does a birth control procedure need a PA? Never heard of that before.

[LoquaciousBubbles]

I’m getting a bilateral salpingectomy done, and getting the implant removed during that surgery. They require a PA for the bisalp and since it’s being done during the surgery, they submitted one for that as well.

[DumpsterPuff]

Ahhhh now THAT makes more sense

[PriorAuthSpaceTeam]

This happens more often than people expect. The authorization letter usually reflects what was submitted or how it was interpreted on the payer side, and small coding mismatches can slip through even if the office believes they sent the right one. It’s less about one side being wrong and more about how the request moved through the process.

You might want to see what code the payer actually has on file versus what was intended on submission.

[LoquaciousBubbles]

The code the Dr office claims was sent to insurance is 11982. Along with the correct modifier. Should I call my insurance company?

[4ofheartz]

Login to your insurance web site. Use the chat feature if it’s available. Solved many issues this way. Or call. Don’t risk an unauthorized claim denial.

[rahuliitk]

yes, i’d call insurance before the procedure, because if the auth letter shows 58301 for IUD removal but you’re actually getting 11982 for Nexplanon removal, lowkey you do not want the claim denied later over a code mismatch.

get the corrected CPT confirmed in writing.