Radiology Coding Alert

The National Government Services (NGS) has listed nine reasons for reducing or denying the claims. These include the following:

1: Documentation did not meet the Local Coverage Determination (LCD) requirements

2:  The documentation lacked clinical indications to support the medical necessity of the study

3:  A bilateral study was billed but the documentation supported a unilateral study

4: Duplicate services/claims were billed/submitted

5:  The documentation was incomplete or missing information in regards to the beneficiary who was being treated

6:  The rendering physician submitted on the claim form was not the physician who performed the service(s) per the submitted documentation

7:  Missing or illegible provider signature: Documentation must be legible and include a provider’s signature. The signature can either be electronic or handwritten; however, stamp signatures are not acceptable.

8: No response to request for medical documentation

9: No documentation was submitted for the billed CPT^® code(s).