[Ouch!]

The codes I have been told by TriCare were code 0092T, and 22857. The codes TBI used were 22857 and 28899.

I first called TBI in early May and talked with the billing department. I asked them for the codes they used for ADR. TBI gave me 2 codes, 22857 and 28899.

I then called TriCare. I told the lady on the other end of the phone that I was looking into an Artificial Disk Replacement and I wanted to find out if they would approve it. I gave her the 2 codes I had received from TBI. She was nice enough to look it all up and told me that 22857 was the code for Decompression of the Lumbar Spine and it might be covered but would have to go to review. Code 28899 was an unlisted procedure and she did not know if it would be covered. She told me code 0092T, Total disk arthroplasty, was approved. She said that was the approved code they were using for disk replacement.

The code the pre certifying person at TBI gave TriCare was code 22857, after I gave her all the code information from TriCare. Several things complicated the problem. First, she waited until yesterday to call for approval. Second, she insisted on talking with someone instead of letting the authorization travel the normal course through the system. So, the person she talked with told her they wouldn’t cover Prodisk. So, all that has been written down for TriCare to review.

I talked with 2 different people today who told me basically, “TBI has to use the right codes” if I want anything approved. I was also told that the authorization was still awaiting review and had not officially been approved or disapproved. The last lady told me that filing the wrong codes would be prejudicial, see if I can find out the codes that have been used successfully by other doctors at other clinics & see if TBI will fix this before I get a rejection. She was pretty helpful and may have told me more than she should.

I called TBI again and asked if they could use the code that TriCare has repeatedly given me. The response was “it isn’t in our billing system. I will have to see if they will use it.”

Of course, now the clock is ticking. It is Friday so nothing will happen before next week. I have to go out of town until next Thursday. I will be in meetings all Monday. The stress is rising.

Thanks for your help.