Wiki L8680

[dbonar]

We are getting a denial from an insurance company stating that dx code 722.73 is not a valid diagnosis code. Does anyone know where I can find information to support this code as an appropriate code for L8680?

 

[rkmcoder]

(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

What is your location, what is your place of service, who is the insurance carrier, and what is the diagnosis (not the code)?

Richard Mann, your pain management coder
rkmcoder@yahoo.com

 

[dbonar]

Office, 722.73, Medical mutual

 

[MMAYCOCK]

Here is the link for the CMS database of NCDs and LCDs.

http://www.cms.gov/mcd/search.asp?from2=search.asp&

You can either search for the national coverage determination or the one for your region and carrier.

Just put in the HCPCS/CPT code or a key word and it will deliver all related coverage determinations.

You can put them in the "basket" and email them to yourself for future reference.

The LCDs and NCDs will have all dx codes that CMS or your carrier have determined meet the standard for medical necessity

Melanie

 

[dwaldman]

722.73 is intervertebral disc disorders with myelopathy. I have not seen SCS procedures performed for disc displacement that is creating myelopathy. Usually the selected procedures would be laminotomy with excision of disc for patient presented with that dx. I would look on the MRI report and re confirm dx with physician.

 

[MMAYCOCK]

The National and Local coverage determinations will tell you which diagnosis codes are acceptable as primary codes and which need to have additional supporting diagnoses to be payable.