Wiki 78452 denial

[smartcoder]

I am new to Cardiology and trying to understand how to resolve this medicare denial I have been seeing for multiple patients. The codes were billed as 78452, A9500, 36000, J0280, J2785, 96375, 96374, 93015, 93040, 93005 all with Dx 402.10. Everything but A9500, 93015 and 78452. Medicare denied for Medical necessity.

I greatly appriciate your help, thank you!!

 

[deeva456]

am new to Cardiology and trying to understand how to resolve this medicare denial I have been seeing for multiple patients. The codes were billed as 78452, A9500, 36000, J0280, J2785, 96375, 96374, 93015, 93040, 93005 all with Dx 402.10. Everything but A9500, 93015 and 78452. Medicare denied for Medical necessity.

I greatly appriciate your help, thank you!!


Helllo,
cannot bill for 36000, 96375,96374, 93040 or 93005. The codes are considered inclusive with the injections and stress portiion of the procedure and cannot code separately.

Dolores. CPC CCC

 

[Amanedmaiston]

You did not post documentation but more than likely you should bill 78452, 93015, A9500 w/2 units, J2785 w/ 4 units. Check your drug codes against documentation to be sure those units are correct. Also check to see if your Medicare contractor has a local coverage decision for stress. That will list all covered dx codes. There are some good articles explaining stress billing if you google it.

 

[rroberts699]

Hello you have to look on www.palmettopga.com under medical policies/LCD AND NCDS and check to see if your diagnosis meets medical necessity.