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909.2 or 990 for HBOT

Bettendorf, IA
Best answers
I have been getting denials from Medicare for hyperbaric treatments (99183) that are diagnosed with 909.2 which is Late Effects of Radiation, comparable to 990 (Effects of Radiation). I have already submitted redeterminations for these with only 1 date of service coming back as favorable (apparently someone else processed this one). My next step is to submit a reconsideration but I am wondering if this is worth my time or could I use 990 and rebill instead? Is there a time frame between it being considered a "Late Effect"? We have thousands of dollars of treatments wrapped up in this between 2 patients, please help!


Best answers
This is just a thought as I do not code for these situations, however I know Medicare --- There is a NCD that allows very limited coverage for HBOT. I have attached the link for you.

As far as the term "late effect" it is classified as problems that can occur weeks, months or even years after treatment has ended. Key word there is ended. If the patient was undergoing radiation and having issues it would be more of a side effect as opposed to a late effect and the 990 codes would be better!