Wiki Billing edit for code 96365

[YOLANDA17]

I am getting this edit---if hcpcs is 96365 diagnosis does not meet coverage guidelines to be billed as covered service.not a covered diag code on the claim for policy in effect for this date of service, source = l30147 immune globulins *medical necessity* [version-12/31/2012, table version-01/02/2013]---it is a bypass edit when should i bypass?

 

[Herbie Lorona]

If I am understanding it right then it is saying that the diagnosis code that was selected for 96365 is not a covered diagnosis for this. If that is the correct diagnosis then you would bypass the edit and bill the claim but it most likely will be denied. If the wrong diagnosis was selected for the code then you would have to get it changed and re-run your edits.