Wiki LCD denials

[bar2ty@yahoo.com]

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!!

 

[MargoR]

I would review the note for any possible signs, symptoms and/or history of to support medical necessity for the service. If you don't have any other diagnosis this is where an ABN should have been completed before the service was performed.

I have not been successful on appealing any LCD/NCD denials.

 

[LisaAlonso23]

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?

 

[Melissa Harris CPC]

What injection is being denied? And is this is a Medicare plan?

 

[bar2ty@yahoo.com]

Which insurance and what are the procedure & diagnosis submitted?

Medicare NJ (Novitas)

 

[LisaAlonso23]

Medicare NJ (Novitas)

Please provide some more information. For example, procedures with diagnosis codes submitted. Your post is a little vague.

diagnosis codes, diagnosis coding

 

[lr09050828@gmail.com]

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.

diagnosis codes, diagnosis coding

 

[LisaAlonso23]

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.

diagnosis codes, diagnosis coding