Wiki 37215 Carotid Stent w/EPT

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bportcardio

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We are receiving denials from medicare for the CPT code 37215 for the carotid stent with EPT. Denial states missing incomplete or other diagnosis. The diagnosis we use is 433.10 for carotid artery occlusion. We we look for the LCD it is no longer available.
Anyone else facing this issue? Is there a new code that was released in April?

TIA
 
We are getting the same denial. When our A/R department calls Medicare(for us Novitas) they are given the information that NCD 20.7. Novitas infers it is a modifier that is missing.

Our carotid stents are not part of a study, so the Q0 is not appropriate.

We are now sending in appeal letters.

I have not been able to find any information on why all of a sudden they are denying them, I can't find anything that has been updated.

I know that doesn't help you much, as I'm in the same boat as you. :)
 
We are also getting this denial as well. Per a Medicare Representative if a patient is not a part of a study trial then we should append a certain modifier on the claim. I can not find this "so called" modifier. Does anyone happen to know what this non trial modifier is? I can only find the trial modifiers. Q0 and Q1
 
carotid denial for no study modifier

We are getting the same denial and have spoken with various Novitas staff and supervisors and are getting contradictory answers. They updated their edits in April to ask for a study modifier on all of these and none of them seems educated enough to know that is a problem. They just read off the edit that we must have modifier. One admitted it was probably an error but was overruled by a supervisor who is sure it isn't an error but can't explain what it is.
Sounds like they put in an edit by mistake but they haven't admitted it yet.
If any of you have figured anything out yet, please share. Otherwise I think we need to encourage everyone to call them because in the past they only fixed a problem after they had hundreds of calls and complaints. If only a few of us they will ignore it.
:confused:
 
Novitas 37215 Carotid Stent denial

We have been told finally that they realize they made a mistake and will reprocess the claims because "multiple people have called attention to this". As always we have to do that because they flat out ignore one or two people telling them there's an error. It would be great if someone else would call and see if they get the same response now. ;)
 
Help

I am also getting claims with same denial reason . we have given appeal documentation on these claims but again we are receving with same denial reason. If anybody find the answer please share.
 
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