Bone Marrow Abnormality

Kdailey

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Seacoast-Dover NH
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I have pathology reports that have provided a final diagnosis of bone marrow abnormality/bone marrow clot after performing CPT 88342. I have tried using 796.4 as well as a couple of other diagnosis codes, but am hitting medical necessity edits. I have been given the task of finding an alternate ICD-9 code code that will not hit mn edits. Does anyone have any suggestions?
 

Tonyj

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Lithonia, GA
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I have pathology reports that have provided a final diagnosis of bone marrow abnormality/bone marrow clot after performing CPT 88342. I have tried using 796.4 as well as a couple of other diagnosis codes, but am hitting medical necessity edits. I have been given the task of finding an alternate ICD-9 code code that will not hit mn edits. Does anyone have any suggestions?
Doesn't sound right for the path report to just say that, but I could be wrong. What was the reason for the biopsy?
 

mjb5019

Guru
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Chantilly, VA
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denied

Try looking up the local coverage determination for the procedure on the Medicare site. It should give a list of medically necessary diagnoses.Then submit that list to your provider and IF THE PATIENT HAS one of the medically necessary diagnoses- have him document that in the note.
 

btadlock1

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Lubbock, TX
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I have pathology reports that have provided a final diagnosis of bone marrow abnormality/bone marrow clot after performing CPT 88342. I have tried using 796.4 as well as a couple of other diagnosis codes, but am hitting medical necessity edits. I have been given the task of finding an alternate ICD-9 code code that will not hit mn edits. Does anyone have any suggestions?
Did you try 289.89? You're definitely being denied due to a lack of specificity - that's a very specific test, so it's going to require a very specific diagnosis to match.
 

btadlock1

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I found a lot of coverage policies on them, but without knowing more about what payer it is, the results won't be of much help. Go to yahoo.com (not google - their results aren't as good for this...)

In the search bar, paste this:
medical necessity immunohistochemistry test

And tack on the name of either the payer you're looking for (eg, UHC, Aetna, Blue)
Or, for govt. payers, enter the name of your state (and for Medicare, add "LCD")

Hit search, and it should pop up on one of the first couple of pages. ;)
 
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