Wiki 36200 denied by Tricare

[Vicki Graham]

Is anyone having trouble with Tricare denying 36200 as global to 75625 and 75716? They are denying even after we submit the report which clearly documents all codes. Has anyone had any success getting the 36200 paid after Tricare denies it? Thanks!

 

[jewlz0879]

Do you have -59's on the 75716 & 75625? I know with the new rules if they were precviously done you are unable to bill for them unless there is a change in the pt's condition and for some other reasons. Take look at pg 373 in your AMA CPT. They outline the rules.

That's what comes to mind.

 

[Vicki Graham]

Hi! Thanks for the help, but no intervention was done. The only thing done was diagnostic angiography with documentation of aorta in the report. 36200, 75625, 75716. I am still at a loss, can anyone help? Thanks!

 

[donnajrichmond]

My guess is that when Tricare put in the edits for cath codes with revascularization (372xx) they goofed and included all angiography. You need to appeal (possibly up to at least the 2nd level) to get them to fix this.