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Please help!!! I need some answers

so over itsso over it Posts: 51
edited 06/11/2012 - 8:25 AM in Back Surgery and Neck Surgery
Okay, I had my 2nd doctor's appointment today and he is standing by his position that I need to have a posterior fusion done. He said he would be doing a dis-service to me by conducting a discectomy for my condition. I had a discogram (which was so painful)done on 10/9 that came back abnormal confirming my L4/L5 disc is torn and leaking fluid. In addition, I have DDD. My pain is off the scale at this point with pain shooting down my right left. I have to say after my appointment I was a bit ~X( because my insurance denied the procedure). Well, I called my insurance company back to find out what other options are there since I've tried all the non-surgical ones. The nurse I spoke to me if my doctor would have indicated that I have "Instability of Vertebrae disc" my pre-certification would have been approved(don't think she was supposed to tell me that). Now I am not a doctor but isn't a torn disc & DDD "Instability of Vertabrae disc"? I'm confused. :?
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Comments

  • Hi

    The wife and I have this sort of problem all the time with codes being used that are not covered by insurance.

    You need to have a conversation with the Doctors staff to get come up with the "correct" code.

    JMO

    Good Luck

    Harry
  • All those little numbers sometimes can cause us the greatest pain. But it is usually contained to the rear end. Insurance companies. ~X I have to call them daily.
  • Yes just get the doctor's staff to fill out the paperwork correctly and you should be good to go. Fusion isn't fun but it sounds like you need it. Make sure you have the right surgeon. You can get reports on doctors to see if they have any lawsuits, complaints, etc. Just do a "surgeon review" search. It helped me decide between 2 MD's who I liked and couldn't decide which one to go with.
  • Yes, ask the doctor to fill the paperwork out again with the correct codes. I have three torn discs and have been told this doesn't necessarily make your back unstable. I do, however, have a lot of arthritis along with the DDD and torn discs, so my back is becoming more unstable. Surgery is next week.

    Linda

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I agree that your surgeon would be doing you a disservice by doing a discectomy. A torn disc must be addressed with a fusion. A discectomy would only address your leg pain and it sounds like you have back pain too.

    And yes, insurance companies can suck. I've worked for a spine surgeon for 5 years. I've seen companies change policies like crazy. Call the business office at your surgeon's office. I'm sure they can help out by simply using different codes. Insurance companies are really becoming sticklers about the DDD diagnosis.
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