I have a question regarding covering 96365 antibiotic administration in ED.
Our ED physician documented UTI as final dx. I coded N39.0 for UTI and B96.89 for bacteria according to documentation. in addition, I added R10.11, R10.12, R11.0, and R50.9. Patient received 25 min of IV antibiotic for which I charged 96365.
Antem insurance is not covering 96365. According to CCI/LCD edit the diagnosis are not covered.
Can someone help me to figure out what else I can add so the insurance will cover it?
“UTI without hematuria, site unspecified. Pt. with kuri symptoms of dysuria and hematuria started on Bactrim on Friday. Today developed bilateral flank pain and nausea. Low fever 38.2.consistent wiith pyelo. Labs are normal. She has a few wbsc in urine along with rbsc, but many epithelial cells. Still 2+ bacteria. Will give rocephin and zofram.”
1529-CCI/LCD Edit charge review
-CPT 96365 is not covered. Noncoverd dx. List. N39.0, B96.89, R10.11, R11.12, R10.0, R50.9.
In other example,
final dx. UTI, DYSPNEA.
ED provider documented: no suspicious of ACS or MI, pneumonia. He feels comfortable going home and return if getting worse. His blood pressure stays the same when he stands up.
Urinalysis, microscopic done, blood, EKG, X-RAY. all negative.
Thank you so much for any help,
NIKI
Our ED physician documented UTI as final dx. I coded N39.0 for UTI and B96.89 for bacteria according to documentation. in addition, I added R10.11, R10.12, R11.0, and R50.9. Patient received 25 min of IV antibiotic for which I charged 96365.
Antem insurance is not covering 96365. According to CCI/LCD edit the diagnosis are not covered.
Can someone help me to figure out what else I can add so the insurance will cover it?
“UTI without hematuria, site unspecified. Pt. with kuri symptoms of dysuria and hematuria started on Bactrim on Friday. Today developed bilateral flank pain and nausea. Low fever 38.2.consistent wiith pyelo. Labs are normal. She has a few wbsc in urine along with rbsc, but many epithelial cells. Still 2+ bacteria. Will give rocephin and zofram.”
1529-CCI/LCD Edit charge review
-CPT 96365 is not covered. Noncoverd dx. List. N39.0, B96.89, R10.11, R11.12, R10.0, R50.9.
In other example,
final dx. UTI, DYSPNEA.
ED provider documented: no suspicious of ACS or MI, pneumonia. He feels comfortable going home and return if getting worse. His blood pressure stays the same when he stands up.
Urinalysis, microscopic done, blood, EKG, X-RAY. all negative.
Thank you so much for any help,
NIKI