Wiki 86800 - Humana diagnosis denials - Need help!

[vidraj]

Hi everyone,

Is anyone facing the diagnosis denials for your practices for the CPT - 86800 from Humana, Humana Medicare?

We have been submitting claims with the E03.9 - Hypothyroidism, unspecified

How to resolve these?Any suggestions.

 

[Papitha]

I do not face the denials; However, as per my review of Humana policies CPT 86800 is only reimbursable during pregnancy. Please check with the respective payer if they follow some state / facility specific rules / guidelines.



I have provided the link below for your reference.

file:///C:/Users/GB17176/Downloads/Laboratory%20-%20Thyroid%20Disease%20Testing.pdf



Hope this helps!

 

[vidraj]

Thank you for your reference.
This helps me to look further.

 

[TThivierge]

Hi Vidraj
Per CPT manual says under CPT 86800 bill CPT 84432 if doing a test (see CPT 80438 or 80439) .If this patient is pregnant did you add pregnancy dx code too such as 099 dx block with E03 dx? I have seen this CPT used for males too. Try E07 DO of Thyroid.
I hope helped you
Lady T

 

[vidraj]

Hi Vidraj
Per CPT manual says under CPT 86800 bill CPT 84432 if doing a test (see CPT 80438 or 80439) .If this patient is pregnant did you add pregnancy dx code too such as 099 dx block with E03 dx? I have seen this CPT used for males too. Try E07 DO of Thyroid.
I hope helped you
Lady T

Hi, sorry for the late response. They are not done for pregnant patients. It was ordered by our rheumatologist to evaluate other system involvement of SLE.

 

[TThivierge]

Hi Vidraj
IF the pt has dx of Rheumoid Arthritis M05.69 as first dx or SLE dx M32 or D68.62 or L93 forms of lupus per documented problems. Then follow up last dx Z code such as Z13.0 or Z13.220. I hope this data helps you
Lady T

 

[vidraj]

I will review it from that perspective.Thank you.