Wiki TAVR denied for diagnosis code/NDC/LCD

[LISA FOUTS]

I have been billing TAVR procedures for over a year with the 62 and Q0 modifiers, the diagnosis as I35.0 (or the correct aortic valve disorder) primary and Z00.6 secondary, with the trial# 01737528 also listed on the claim. Starting around July 2020 UHC started to deny the claims stating diagnosis not supported per LCD/NDC, then in Oct 2020 Traditional Medicare (WPS) started to deny for the same reason. Up until that time all my claims were being paid with no problems. Our local UHC rep wasn't any help with the issue after we let her know that 2 claims billed the exact same way (1 for CT surgeon and 1 for interventionalist) one was paid and the other denied. We had emailed her asking why that was, but she just never emailed us back. We have sent records because of the modifier 62 pointed out that the trial # is correct on the claim and it was still denied. After reading info on UHC and the LCD/NDC I noticed that they did not have diagnosis code I35.0 (or any other aortic valve disorder) listed and only talked about Z00.6. I then billed a couple of claims without the I35.0 to see if that could be the problem and they have been denied also for lack of diagnosis.

Thanks for your help!