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Wiki Cpt 90281

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Timothy S

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Hi Everyone, need help on this one.

Medicare denied the CPT 90281 with Dx 794.31 as Procedure/treatment is deemed experimental/investigational by the payer and we are unable to find other Dx in the medical records except V70.0.
 
Timothy S said:
Hi Everyone, need help on this one.

Medicare denied the CPT 90281 with Dx 794.31 as Procedure/treatment is deemed experimental/investigational by the payer and we are unable to find other Dx in the medical records except V70.0.
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I don't know if this will help you but when we bill TAVR's we have to append a V70.7 (Exam of participant in clinical trial) as a second diagnosis. Good luck :)

You may also want to look at modifier Q0 (Investigational clinical service provided in in a clinical research study that is in an approved clinical research study)
 
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To better address the question it would be interesting to to see the note in this case. Your dx code is an abnormal EKG, and you have a code for IM immunoglobulin. what did the provider document as the need for the immunoglobulin, it was not just because of an abnormal EKG.
 
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