Subject: RE: medical opinion//training exam //dani//solidarity//aubmc//24a3177// turb
From: Nicolas Abdallah <[email-masked]>
To: Mohamad Issa <[email-masked]>, Jose Kmeid <[email-masked]>, Lara Ghaddar <[email-masked]>
Cc: Toufic Jomaa <[email-masked]>, FLS <[email-masked]>
Date: Mon, 28 Oct 2024 09:54:42 +0000

Hello,

  *   We need the result of the old pelvic ultrasound (in 2016), as well as the date and operative report of any previous genitourinary procedure done, if any. The stricture of the bulbar urethra can be a complication of a previous procedure, so we might be dealing with a false declaration here.

  *   After ruling out false declaration, the procedure is medically indicated for such a case. However, we still need a report detailing the patient's symptoms and the medications he was taking.

  *   The CPT code is adequate only if the operative report states that "complete vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy" was done. Otherwise, a less expensive code would be billed. Below are the different codes for TURP with their K value for your reference:

52601
Transurethral resection of prostate including complete vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy
100
52612
Transurethral resection of prostate
60
52640
Transurethral resection: of post operative bladder neck contracture
40

Thank you,

Dr. Nicolas Abdallah
Medical Controller
[Test sad asdasd]
(+961) 1 492 249

www.mednetliban.com<http://www.mednetliban.com/>

From: Mohamad Issa <[email-masked]>
Sent: Monday, October 28, 2024 10:26 AM
To: Nicolas Abdallah <[email-masked]>; Jose Kmeid <[email-masked]>; Lara Ghaddar <[email-masked]>
Cc: Toufic Jomaa <[email-masked]>; FLS <[email-masked]>
Subject: medical opinion//training exam //dani//solidarity//aubmc//24a3177// turb

 Dear Drs,

Kindly find below the case of mr Dani  61 years old ,subject to underwriting with continuity. Inception date 1/12/ 2020 He requires admission for turb:  Stricture bulbar urethra dilated and incomplete removal adenoma and bladder neck very tight as per flexible  cystoscopy done 16/09/2024.and in 17/10/2024 echo done : result below
                    Clinical Indication
                  LUTS and sever obstructive urinary symptoms.
                 Technique
                 Real-time, grey-scale ultrasound images of the pelvis.
                 Comparison 18 March 2016.

               Findings
             Both kidneys are normal in size and echogenicity revealing
             normal cortical thickness and corticomedullary differentiation.
            The right kidney measures 11 cm in length.
            The left kidney measures 12.5 cm in length.
            No evidence of hydronephrosis or stones on either side.
            The prostate gland measures 43 cc in volume, previously 60 cc.
            Median lobe is slightly enlarged impinging on the bladder
            base.
            The bladder is adequately distended to a capacity of 200 cc

Please advise with your medical opinion regarding the necessity of the procedure  and :

  1.  Is the cpt code related to this procedure .
  2.   echo results 2016 requested with detailed report to check the psmh since as per result previous cystoscopy  we have incomplete removal of adenoma . and need old pathology to check if any false declaration .

  1.  If the case related to old procedure or not  to check if any malpractice  .

Case summary for medical opinion

Patient's Name

dani

Reference number

24a3177

DOB

61yo

Insurer

Solidarity gold

Individual/Group/Group name

 individual

Product/Class

a+nssf

Underwriting

yes

Inception Date

01/12/2020

Continuity to date

Yes

Imported From

n/a

Provider Name

aubmc

Special Limitation/Exclusions

n/a

Procedure

turb

Approximated Estimation Cost

3500usd

CPT Codes

52601

Physician's Name +Mobile

Rami nasr

Prosthesis Cost(When applicable)

n/a

Prosthesis Coverage as per TOB

n/a

Admission Date

 29/10/2024

Circumstances Of Trauma

n/a

Medical Decision

ICD 10

Approved Procedure:

Specific Remarks:

Regards

Mohamad Issa

[Test sad asdasd]

(+961) 1   492 249

(+961)

www.mednetliban.com<http://www.mednetliban.com/>

Mohamad.Issa<mailto:[email-masked]>@mednetliban.com<mailto:[email-masked]>