NESmith
Expert
Good Morning, I need some help on this one. My GI provider saw a patient that presented to the office with abdominal pain RUQ for 2 years. In his assessment he states abdominal pain-R/O GB disease, R/O hepatic flexure syndrome and abdominal pain-RUQ. He did a EGD and we billed Tricare CPT code 43236 with dx 789.01. Tricare is denying our claim stating that this needs to be billed with a screening dx. We have sent notes and a letter of Medical Necessity, but they are still denying for a screening dx. What is your take on this and is this correct for them to be asking for a screening dx? Thanks for your help.