Wiki BCBSM Drug code Denial

[rahulbhaleraog@gmail.com]

Hello All,

I am noticing BCBS Michigan is denying drug code with denial code PR167, we have auth for the codes billed. For Example, CPT code J9173 unit 150 billed with DX C23 got denied for PR167. I have checked NCD and the coding is correct as per the guideline, If anyone has any idea how to overcome this denial, please help.

 

[sls314]

Hello All,

I am noticing BCBS Michigan is denying drug code with denial code PR167, we have auth for the codes billed. For Example, CPT code J9173 unit 150 billed with DX C23 got denied for PR167. I have checked NCD and the coding is correct as per the guideline, If anyone has any idea how to overcome this denial, please help.

PR167 is a denial related to the diagnosis code.

What diagnosis code is being billed? Does it match the diagnosis code that was on the authorization?