Wiki Consult Code Denied

[terif]

Medicare just denied a Pre op consult 99244 for the date of service 12/15/09 stating "not covered under patient's current benefit plan". The appropriate diagnosis codes and referring doctors are documented. Has anyone ever heard of this?

 

[Karolina]

Hi - I would appeal this. It may well be that the system is not sensitive to the fact that at the time of service the consult code was still valid.
I assume that you made sure all criteria for a consult and the level are supported by the documentation.

 

[terif]

I was thinking the same thing but wanted to be sure thanks!

 

[Walker22]

Another circumstance I have run into occasionally is if the patient has an outstanding liability claim (e.g. traffic accident), sometimes a particular diagnosis will trigger a rejection like this. Basically they are saying that for that particular dx, Medicare is not the responsible payer, but for other dx's they are. It doesn't happen often, but it's something to check out.