Wiki 10005 DENYING FOR DIAGNOSIS

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tastreet

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Hello everyone,

Has anyone had any issues with 10005, or 10006, denying for diagnosis when you use E04.1 or E04.2? If so, what did you do, or find out?

Per Mayo Clinic the fine needle aspiration is a valid test that providers perform for testing nodules and goiters. No matter what informaiton we have provided, including records, this continues to deny for diagnosis? Just looking for some education on the matter if anyone is able to help. Thank you so much!
 
Who is the payer? Was there anything else billed with it? What was the biopsy result? Did you check the payer's coverage guidance (like an LCD/NCD)?
 
amyjph said:
Who is the payer? Was there anything else billed with it? What was the biopsy result? Did you check the payer's coverage guidance (like an LCD/NCD)?
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It is Optima and they have little resources for coverage guidelines. They just keep denying it "not covered when performed for the diagnosis reported". Nothing billed with them. The results vary per patient, but all patients are denying despite result...and thank you for your time!
 
amyjph said:
Just if looking on EnCoder, those two diagnoses are not listed as options for those codes.
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Thank you for taking a look. I have been going back and forth with them on this. I wasn't sure if there is something I am missing. I truly appreciate your time.
 
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