# Cpt 85018 - E/M to Medicare



## JRC (Sep 30, 2009)

Hi,

We have billed CPT 85018 with an office E/M to Medicare, 
we received payment for E/M but CPT 85018 was denied as not covered.

Can anyone help me to get this claim paid.

Thank You
JRC


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## zulkos (Sep 30, 2009)

Apending a 25 Mfr to the e/m.


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## kbarron (Sep 30, 2009)

Did you use the QW modifier?


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## JRC (Sep 30, 2009)

Yes Karen we used QW on CPT 85018


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## tanyaharberts (Oct 2, 2009)

What dx was linked?


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## JRC (Oct 4, 2009)

280.9 was the dx used


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## tanyaharberts (Oct 5, 2009)

I would appeal.  280.9 (Iron deficiency anemia, unspecified) should be covered for 85018 (Hemoglobin).  It is not listed in either the non-covered diagnosis section or the medical necessity section of NCD 190.15 (Blood Counts).  Refer to this NCD at:
http://www.cms.hhs.gov/CoverageGenInfo/downloads/manual200910.pdf#4


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## JRC (Oct 6, 2009)

Thank You


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## CMHOULE (Jun 21, 2013)

*cmhoule*

can you tell me if modifier 26 must be appended to the 85018 ?

thanks


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