Wiki Billing Question

[tcoder5]

Can anyone help with the following scenario? Medicare denied the claim indicating that guidelines were not met.

Dr. L saw the patient on 07/02/13 for CPT Codes 11721- 59Q9 and 11056-Q9. Dx codes used were 355.8, 701.1, 110.01- billed in this order.

Thank you, in advance, for any help.

 

[JJaggers]

Lcd

Was this a CO-50 denial reason code?

You may want to follow this link and check the LCD guidelines for these codes. If the DX codes you have used do not follow the codes the CPT will not be covered.

http://www.cms.gov/medicare-coverag...MAC+%252D+Part+B%2529&letter_range=4&retired=

If this doesn't help, please let me know.

 

[tcoder5]

The denial reason was as follows:

PR-BS : Coverage/program guidelines were not met or were exceeded.

 

[Squiabro]

There are two coding errors. 110.01 does not exist. Perhaps you meant 110.1 linked to CPT 11721. Also ICD9 701.1 is not deemed medically necessary for the use of CPT 11056. Link ICD9 code 355.8 to CPT 11056.

 

[tcoder5]

Oops, yes I meant 110.1. Thanks for the information.