Wiki LCD denials

bar2ty@yahoo.com

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Fuquay Varina, North Carolina
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Many of our claims are being denied for non-covered services because this is not deemed a medical necessity by the payer-based on LCD. I review the LCD list and the dx code is not listed, and there is no other dx code appropriate for px. Can we appeal these claims to get them paid? What are some steps we can do to get these claims paid? Please HELP!!
 
Many of our claims are being denied for non-covered services because this is not deemed a medical necessity by the payer-based on LCD. I review the LCD list and the dx code is not listed, and there is no other dx code appropriate for px. Can we appeal these claims to get them paid? What are some steps we can do to get these claims paid? Please HELP!!
Which insurance and what are the procedure & diagnosis submitted?
 
For my GI group there is a LCD for medical necessity for MAC anesthesia. If there isn't a dx code on the list that we can't find in the patients chart...we have to adjust. Or do a ABN on file w/a signature.
 
For my GI group there is a LCD for medical necessity for MAC anesthesia. If there isn't a dx code on the list that we can't find in the patients chart...we have to adjust. Or do a ABN on file w/a signature.
I would be happy to look at the coding for the denied claims and anesthesia records. You can use the Snip tool in Windows to send it to me via email. Please leave out personal information due to HIPAA. My email is LisaAlonso23@gmail.
 
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