Typanometry (92567) Appeal Letter

As promised earlier, here is an excellent version of an appeal letter for bundling of the 92567 CPT code (Typanometry).

I will include the text of this one below, as well as PDF, OpenOffice, and M$ Word versions. Thanks, Bonnie! Great stuff!

Your Practice Name
Address
City, State ZIP
Phone
July 1, 2008
APPEAL LETTER
Insurance Company
Attn: Appeals Department
Address
City State Zip
Attn: Appeals Department
RE: Patient Name
ID#: XXXXXX  Claim #: 2XXXXXXXXXX
DOS: 01/01/01 Patient #: 1234
Procedure Code: 92567
In response to your request for documentation supporting the need for including the above procedure in my examination of <patname> on the above date of service, I would ask that you review the attached summary flowchart from the American Academy of Pediatrics which documents the necessity for objective hearing evaluations at predetermined intervals. Please see page 3 and page 30 from the 2008 CPT Manual instructing separate reporting of diagnostic tests/studies for which specific CPT codes are available when performed during a preventive visit. The manual describes the “ordering” of appropriate diagnostic procedures, not the “inclusion”; otherwise, you might argue that even hematorcrits, urinalyses, cholesterols and immunizations should be bundled under the payment of 99393.
Chronic asymptomatic serous otitis media is a common problem in childhood, which can lead to speech and language disorders in young child and school problems in a school aged child due to impaired hearing. This is often times not ascertainable on physical exams but is detectable with impedance testing (Code 92567). Schools have used this screening technique for decades to screen for medical problems that interface with
learning.
As a physician, it is my responsibility to the patient to exercise due diligence in diagnosing and treating the obvious and the less obvious. There is ample support from the American Academy of Pediatrics indicating the necessity of good hearing evaluations on a regular basis. I would also like to add that I frequently detect problems
which the patient or the parent is unaware of. I would appreciate your consideration of payment for Code 92567 as a separate
procedure.
Your Name, Signature

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