# Care Improvement Plus and LCD L32628



## missyah20 (Aug 27, 2013)

Good Afternoon,
  I was wondering if anyone else out there has been receiving denials from Care Improvement Plus relating to the Novitas MAC LCD L32628. 

  If so, how have you been appealing these?

  I have multiple denials for my CRNA stating that my claim does not support medical necessity.  An example would be a colonoscopy billed with the following codes:
1)V7651
2)25000
3)496
Codes 25000 and 496 are included in the list of ICD-9 codes in this LCD.

My response to be 1st appeal has usually been "... was denied based on LCD policy ID (L32628).  The diagnosis code indicated on the claim is not included in the list of ICD-9 Codes that support medical necessity on the LCD."

Most recently I recevied one stating: ". . . V7651 should not be used as primary diagnosis."

I have called to Provider Customer service and have tried to explain that you wouldn't link a supporting diagnosis to the procedure since the reason they are having the procedure is listed as primary and the support for the separate anesthesia provider comes from the secondary diagnosis.  However, I have gotten nowhere and I can't seem to get them to overturn their original denial when I know that these claims have the information to support and would have been pd by Medicare. 

Any suggestions on how else I can approach these denials would be greatly appreciated.


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## dwaldman (Aug 27, 2013)

I would appeal in writing to CIP first. And then if it is denied I believe that there is mention of additional way to appeal where an outside entity reviews the denial and sees if seems that it is appropriate.


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