Question 87798

Tara0513

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I am hoping someone out there can guide me in the right direction. I work for an independent laboratory where we process specimens for respiratory (bordetella), women's panel (STI, bacterial vaginitis, lactobacillus, etc), diarrhea pathogen panel along with additional tests (H-pylori and listeria). We have been using 87798 for some of the stated testing, and now Horizon BCBS, Aetna and Humana have been denying our claims straight out or requesting medical records before paying. It has become a full time job to send the medical records (we don't have anything but a requisitions and the referring providers will not send out medical records for us), to the point that we might need to hire more employees just to handle the volume of medical records request. Just wondering if anyone else has been hit with this issue? If so, have you had any luck with getting the claims processed? Is there anything we should be doing differently? Maybe we are using the wrong cpt code? I have researched all codes, and looked up each medical policy and I can not find where this code is an issue.
I appreciate any feedback.
 

danachock

Guru
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Brainerd, MN
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Hi Tara0513,
Yes, I have had the opportunity to work many denials with procedure 87798. Back when I was a laboratory coder a few years back ....we purposely had this procedure stopped so I could simply add the procedure description to the laboratory test being performed.
CPT book states 87798 - Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism. Any insurance company out there is clueless on what laboratory test is actually being performed.
Procedure 87798 Is NOS - I ran procedure 87798 through our facility's laboratory catalog this evening and there was nearly 70 different possibilities for procedure 87798. Unsure what needs to be done on your end, but simply stop (some type of edit) the procedure and "add the procedure description". Back a few years when these were being denied - I had so many denials (and questions on this) that I actually requested my supervisor to place a ticket to have this procedure stopped so we could add the necessary procedure description(s) (information).
Please do not be discouraged.... insurance company wants medical records to support reimbursing 87798 - you only send them the lab requisition and a copy of the laboratory test being performed that proves what is being tested to secure that reimbursement. If your appeal is denied ~ personally reach out to me and we may be able to perform a secondary appeal.
Thanks for listening and have a great evening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPB, CPMA
 

Tara0513

Contributor
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Hi Tara0513,
Yes, I have had the opportunity to work many denials with procedure 87798. Back when I was a laboratory coder a few years back ....we purposely had this procedure stopped so I could simply add the procedure description to the laboratory test being performed.
CPT book states 87798 - Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism. Any insurance company out there is clueless on what laboratory test is actually being performed.
Procedure 87798 Is NOS - I ran procedure 87798 through our facility's laboratory catalog this evening and there was nearly 70 different possibilities for procedure 87798. Unsure what needs to be done on your end, but simply stop (some type of edit) the procedure and "add the procedure description". Back a few years when these were being denied - I had so many denials (and questions on this) that I actually requested my supervisor to place a ticket to have this procedure stopped so we could add the necessary procedure description(s) (information).
Please do not be discouraged.... insurance company wants medical records to support reimbursing 87798 - you only send them the lab requisition and a copy of the laboratory test being performed that proves what is being tested to secure that reimbursement. If your appeal is denied ~ personally reach out to me and we may be able to perform a secondary appeal.
Thanks for listening and have a great evening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPB, CPMA
Dana--thank you so much for your response! We did start the process of adding the description to the claim for the reason of using 87798, hopefully this does help. I really appreciate the help, and will definitely reach out to you again. Thank you Thank you Thank you!!
 

danachock

Guru
Messages
214
Location
Brainerd, MN
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Hi Tara0513
I wish you copious amounts of success with your new workflow process.
I have to believe wholeheartedly that this decreased the amount of PI's (patient inquiries), and emails received by you.
Again if you need help PM me or type a post and I will try to assist you.
Thanks and have a great evening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
 
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