Wiki Blue Cross NC a1c denials

[pudge2465@yahoo.com]

Is anyone getting denials for a1c stating "Diagnosis inconsistent with CPT" when the dx code is appropriate, i.e. E11.9?

 

[Cgarciagfp1234]

our office has been getting these denials as well. Seem to go back to around May 2025. BCBS has denied dx E11.65; E11.9 and E11.69 as co11 billed dx inconsistent with procedure. These are all appropriate to bill. When we call BCBS they tell us to see the A1C policy. BCBS has paid under these dx prior within this year. I can not find a change in policy for payor. We were also advised to check Avalon which is used by BCBS. I don’t see how this is useful as you only list the patient dob, dos, dx and the cpt code. I feel this maybe a payor issue as we are not seeing it with any other insurance. Has anyone received any other info on these denials or what to do to resolve? I have thought about reaching out to our payor rep but wanted to see if anyone else has any insight