0238T denial

iamlou

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Is anyone else having trouble with denials on 0238T? Medicare is denying our entire claims that have that code on them saying not medically necessary. I don't understand because the pt is coming in with CTO of the iliacs. I'm charging for the angioplasty and stents that are done in this area as well, but the whole claim is being denied. I'd think that CTO should qualify as medically necessary. Thoughts?
 

Jim Pawloski

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Is anyone else having trouble with denials on 0238T? Medicare is denying our entire claims that have that code on them saying not medically necessary. I don't understand because the pt is coming in with CTO of the iliacs. I'm charging for the angioplasty and stents that are done in this area as well, but the whole claim is being denied. I'd think that CTO should qualify as medically necessary. Thoughts?
Medicare is probably saying the atherectomy is expermental, so they are not paying for that. So bill 37221 for the iliac stent placement.

HTH,
Jim Pawloski, CIRCC
 

cpleasant

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Medicare is probably saying the atherectomy is expermental, so they are not paying for that. So bill 37221 for the iliac stent placement.

HTH,
Jim Pawloski, CIRCC
Hi Jim, I am also having denials for 0238T. Would we just leave off the 0238T and bill the 37221? As of now, they are denying the entire claim.

Thanks, Carla Pleasant, CPC
 

Jim Pawloski

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I don't know if you have appealed the denial for 0238T, but if you have, then I would bill for the 37221 alone.
HTH,
Jim
 
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