Clinical Trial Number????

Jess1125

Expert
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403
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Green Bay
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Hi,

I rec'd a denial from UHC Medicare Complete for carotid stenting, cpt 37215, stating "missing clinical trial information". I've coded this procedure out a handful of times without clinical trial number and never had any issues. I'm aware that this is an inpatient procedure but that's really the only thing I'm aware of about this code. I don't ever recall hearing this code needing a clinical trial number. Anybody run into this?

Jessica CPC, CCC
 

bridie25

Networker
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Tampa Bay
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Clinical Trial NUmber

I went back and forth with Medicare about this issue, before they finally told me it was for a clinical trial number. I called them about this again and they said they are following an NCD( I cant remember the number) from 2007, they were not enforcing it but all of a sudden starting last year they decided to enforce it.

The NCD basically says when you perform a Carotid stent and the DX is Carotid stenosis you need the clinical trial number.....not sure why because what other reason would you do a carotid stent.


I don't think there are even clinical trials for this anymore, but of course Medicare does not know when they are going to update this. I have recommended that my providers get an ABN signed.

Sorry I could not give you good news.
 
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