| Dupuytrens RT in the USA |
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02/18/2011 04:22
LubaM. 
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02/18/2011 04:22
LubaM.
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Re: Dupuytrens RT in the USA
flojo:
Thanks so-oooo much Lori. I need these. I will be using them to pursue payment by Medicare.
Scripps is now saying that Medicare didn't pay so they are billing me. Medicare said Scripps did not provide medically needed procedure documentation or justification.
When I called Scripps and told them they paid the first time, she said they wrote it off because it wasn't billed in a timely manner or something like that. I will be working on getting this resolved. Bummer!
Luba, have any issues come up for you about Medicare paying for RT through Scripps?
Flora,
The only time I had RT in Nov. 2009 at Scripps, Medicare paid first and Blue Cross PPO paid as secondary. I was not billed for anything.
Are you saying that Medicare doesn't pay now? indeed bummer...because I was considering going to see Dr. T. to check on an area of my left hand (outside of the radiated area the first time) where new nodules have appeared.
Keep us posted on how it goes with your claim.
regards
Luba
Edited 02/18/11 06:23
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02/18/2011 11:18
Larry
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02/18/2011 11:18
Larry
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Dupuytrens RT in the USA - Training Course for RT's and Us ??
Just an idea which I got last night ...
As more doctors start to do radiation the more it will be necessary to get them
trained to do the correct inspection and palpation of hands and feet - I think
the clue for any proper treatment mangement, as the Underestimation of
Dupuytren's Disease would result in "relapses" or unsuccessful treatment.
Moreover, we - as the affected patients - should get physical training to do the
appropriate examination ourselves ! Why not? Aren't we the ones who feel and
see what's going on ?
Wouldn't it be great to gather at some place in the US and have the prominent
doctors come and examine us and get a handle on their specific terms of decision
making ... either wait & see versus radiation versus any surgical technique ?
Clearly, it would be a patient's driven event and eventually not every invited doctor
would really show up and tell us his "secrets" - But Let's Think about this further
and gather opinions ...
Larry
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02/18/2011 14:21
flojo
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02/18/2011 14:21
flojo
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Re: Dupuytrens RT in the USA
Larry,
I like your idea. If there is any way possible, I'll be there.
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02/18/2011 17:34
LubaM.
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02/18/2011 17:34
LubaM.
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Re: Dupuytrens RT in the USA
I agree... I think that RT is "picking up momentum"...at least on this forum...for early treatment of DD and LD.
Remember how when NA started to become popular 6-8 yrs. ago many doctors travelled to France to learn the procedure with the "french" doctors and eventually Dr. Eaton trained many doctors in the U.S. for the procedure? Wouldn't it be wonderful if doctors who are doing/want to do RT could train with Dr. S. in Germany and get the knowledge/experience from the top expert in the field?....just a thought....
Edited 02/18/11 19:35
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02/18/2011 20:11
flojo
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02/18/2011 20:11
flojo
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Re: Dupuytrens RT in the USA
Luba,
Another good idea. Unfortunately we can't make the RT docs do it. Maybe it will catch on at some point.
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02/19/2011 13:49
David26not registered
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02/19/2011 13:49
David26not registered
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Re: Dupuytrens RT and Coding
lauriw:
Lori,
That is really good to hear. We are waiting for approval, they have been dragging their feet. I was supposed to have a CAT scan yesterday, but had to cancel because we had not heard from BCBS yet. I do have the code 728.6 benign condition contracture. If you know of other codes that would be helpful. Do you know why one doctor would want an MRI vs my radiologist wanting a Cat scan? If they deny my claim would you be willing to talk to me and let me use you as an example of BCBS paying for the RT and do you know how I could line up a couple of other people that had the treatment with BCBS?
I am so glad you responded. My doctor would be the first in Iowa and I know others with the disease that would have a doctor to go to. I have a lot of faith in his abilities, and since I am not going to Germany, I am hopeful he will do a good job.
Thanks again so much for responding to my question!!!
Lauri
Lauri, some more info that might help. Outpatient RT does not require BC/BS pre-approval per my contact with them prior to my treatment in May 2010.
There are two coding systems (I think, I am not an expert here). ICD-9 codes are diagnostic codes. 728.6 is an ICD-9 code. CPT codes are procedure codes for medical treatment provided. The codes Lori gave are CPT codes.
You can google up reference material to check on them. Here are a couple of places.
ICD-9 http://www.icd9data.com/2010/Volume1/710...728/default.htm
CPT https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
I had a cat scan. Some people have an MRI. My understanding is they are done to assist with the RT depth and also help in identifying the correct field to treat. Someone else can better answer but my understanding is it is just the radiologist's preference.
There is a lot of support for radiation therapy of DD. Many reputable online sources refer to it and you can see from this board that RT is gradually gaining more and more support among the medical community. The potential savings to the insurance plan should be enough to justify the treatment. I had a co-worker who just had open surgery for DD. He said the billing was over $50,000. If you don't have RT to attempt to stop/slow the progression, then further procedures are inevitable. The ultimate costs will be much higher to the plan and ultimately to all the plan participants who are sharing in the cost by paying premiums.
It might be a good idea to start a thread and add all the links where a prominent resource or expert recommends RT for Dupuytren's. This is a UK article but an example of what I'm talking about.
http://www.dailymail.co.uk/health/articl...awed-hands.html
Edited 02/19/11 20:49
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02/19/2011 15:08
lori
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02/19/2011 15:08
lori
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coding of RT and DD
David and Lauri,
You are welcome Flora. So sorry about you having medicare problems, how horrible after having it paid for the first time.
Yes the codes I gave Lauri are CPT codes and are my codes the RT was billed/submitted to insurance under. Her diagnostic code was accurate. Since I work in an office that uses CPT codes, I have a CPT code book should anyone else want to know what their procedure code means.
Code: 728.6
"Description: Disorders of muscle, ligament, and fascia:
Contracture of palmar fascia
Notes: Dupuytren's contracture"
Denial of service based on "medically necessary" means her BCBS is stating her RT is not (quoted from my BCBS service book) B: "necessary for and appropriate to the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease or its symptoms.", C: "within generally accepted standards of medical care in the community."
Excuse any spelling errors.
If we can get the specialist to come to one location for consultations, I will go. Great idea.
Lori
Edited 02/19/11 17:10
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02/19/2011 16:33
David26not registered
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02/19/2011 16:33
David26not registered
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Re: Dupuytrens RT in the USA
One thing I just noticed. These two websites used to have a discussion of radiation therapy as an approved alternative approach to treating DD. I just went back and reviewed them and the RT references are no longer there. Either I've missed something or there is something going on behind the scenes that prompted the removal. Sorta strange for this to disappear.
Mayo Clinic http://www.mayoclinic.com/health/dupuytr...ments-and-drugs
Web MD http://arthritis.webmd.com/tc/dupuytrens...atment-overview
These are rather basic online medical sources but they are used by millions and it was helpful for them to ratify RT as a method of treatment.
Edited 02/19/11 20:51
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02/20/2011 00:33
lauriw 
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02/20/2011 00:33
lauriw
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Re: Dupuytrens RT in the USA
Wow, David, are you saying the Mayo used to talk about RT for DD? I have been through their web site numerous times and yes, I know they don't list RT. So the insurance companies got to them!! That makes me sick. We really need to band together and get these doctors that will work with us out and work on the ones that refuse to treat. This feels creepy. I want to thank everyone for your help. I will fight to get another radiologist and another state on the list of place people can go go RT!
LauriW
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02/20/2011 00:53
LindaM 
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02/20/2011 00:53
LindaM
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Dupuytrens RT in the USA - Phila treatment center
Hi,
I am in the very early stage of Dupuytren’s and Ledderhose. Does anyone know of a radiation treatment center in the Philadelphia area? I’m just starting my research and it appears that RT is the best option.
Thanks,
Linda
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