Wiki C49.22 Medicare denying

[sidney01@roadrunner.com]

The patient has myxofibrosarcoma of the left calf. Humana Medicare is stating they need another diagnosis code?

 

[whatwouldyousay]

Are they asking for an additional diagnosis code or a different diagnosis code?

What procedure are you billing for... maybe it has something to do with an LCD policy for the procedure.

 

[sidney01@roadrunner.com]

Patient is receiving radiation therapy treatment IMRT. I have tried to find information on the LCD policy but am not finding anything.

 

[sidney01@roadrunner.com]

I could possibly add another diagnosis code. Not sure what that would be though.

 

[sls314]

I could possibly add another diagnosis code. Not sure what that would be though.

For the treatment delivery, are you using Z51.0 (Encounter for antineoplastic radiation therapy) as your primary diagnosis?

Also, what was the diagnosis submitted on the authorization request for IMRT? Some payers may be picky about the billing diagnosis vs authorized diagnosis.

 

[sls314]

Patient is receiving radiation therapy treatment IMRT. I have tried to find information on the LCD policy but am not finding anything.

Most MACs don't have LCD for radiation therapy, and there is no NCD.

 

[sls314]

BTW - if you would like also to bounce the question off other radiation oncology coders (and also a few clinical people), there is a group for rad onc coders and billers. We're up to almost 900 members now.

You're welcome to join if you'd like. It's generally a pretty helpful bunch. https://www.facebook.com/groups/radiationoncologycoders/

 

[sidney01@roadrunner.com]

yes, I am using Z51.0 for my primary. I checked with pre auth and they also used C49.22 as the diagnosis for pre auth. I am on the FB page! I love it!! Thank you.
Thank you both for your responses!