Wiki 83036 A1c Denials

[klester2018]

We are a Family practice and we are getting a lot of denials for the A1c for the dx code E11.65. Is anyone else having this issue? Any suggestions? It was mostly Cigna Medicare but now other insurances are denying as well.

 

[Cynthia Hughes]

No easy answer on this one. You would need to access the CIGNA plan's policy for A1c testing to see what diagnosis codes (E11.65 should be good.), frequency of testing (usually 90 days), etc. are covered by the plan. If no answers are found there, it may be necessary to contact provider services to see if there is a glitch in the claims system.

One other thought is that additional codes should be reported with E11.65 to indicate the medication or insulin that is used forcontrol of the patient's diabetes (eg, oral hypoglycemic drugs (Z79.84)).

Not sure this helps much but hope it puts you on the path to an answer.
Cindy

 

[klester2018]

No easy answer on this one. You would need to access the CIGNA plan's policy for A1c testing to see what diagnosis codes (E11.65 should be good.), frequency of testing (usually 90 days), etc. are covered by the plan. If no answers are found there, it may be necessary to contact provider services to see if there is a glitch in the claims system.

One other thought is that additional codes should be reported with E11.65 to indicate the medication or insulin that is used forcontrol of the patient's diabetes (eg, oral hypoglycemic drugs (Z79.84)).

Not sure this helps much but hope it puts you on the path to an answer.
Cindy

Thanks Cindy