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Clover Health denials for LCD A57361, CPT 00731

B

bar2ty@yahoo.com

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27
Location
Fuquay Varina, North Carolina
Clover Health of NJ is denying all our claims for LCD L35049, A57361 for the diagnosis is inconsistent with the procedure. The procedure cpt code is 00731/AA-upper gastro endoscopic. The diagnoses listed in this order is Z87.19, K25.9, i10, Z87.891. I have disputed this, but Clover is still denying for LCD. My first concern is that LCD A57361 pertains to a MAC but this was a General anes. My next concern is should the order of dx be changed. We have over 400 claims denied for the same reason-LCD L35049, A57361-in some cases a MAC was performed and there is a dx code listed on the claim that is on the LCD list, but they are still denying for LCD. I have tried repeatedly to speak with a supervisor to no avail, and claims was escalated to their claims team, but no changes or response. Is anyone familiar with anes billing Clover Health of NJ?
 
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