kayleeevans907
Networker
My practice is getting denials from Medicare for patients who are coming in to get tested to abide by travel mandates in our state, wanting to ensure they don't have the virus before visiting a local family member or just want to be tested for peace of mind.
The argument is that the above listed reasons are not enough to support the test being medically necessary (we are billing them out as Z11.59 since these patients are asymptomatic). I reviewed this with the provider who leads the department at our practice that does the most testing and his view on it (paraphrased of course) is that since we live in a state/city where community spread has been identified everyone is considered exposed; due to this the preference would be to document in each person's chart that due to current community spread/PHE status within our state testing is medically necessary.
I see both sides of this, it seems the base of the reasons are more social obligation than health-related, but this is not the only provider within our practice (or community) that has taken this stance. Is it appropriate to give a "go-ahead" to document that community-spread=everyone exposed and bill with coding to show that they're exposed?
Previously we were billing Z11.59 and this is what was causing denials, we would likely be switching to Z03.818 for asymptomatic exposure.
I would also GREATLY appreciate any links/articles on why this isn't ok if so, the more information I can get my hands on before giving a final answer the better.
Thank you
The argument is that the above listed reasons are not enough to support the test being medically necessary (we are billing them out as Z11.59 since these patients are asymptomatic). I reviewed this with the provider who leads the department at our practice that does the most testing and his view on it (paraphrased of course) is that since we live in a state/city where community spread has been identified everyone is considered exposed; due to this the preference would be to document in each person's chart that due to current community spread/PHE status within our state testing is medically necessary.
I see both sides of this, it seems the base of the reasons are more social obligation than health-related, but this is not the only provider within our practice (or community) that has taken this stance. Is it appropriate to give a "go-ahead" to document that community-spread=everyone exposed and bill with coding to show that they're exposed?
Previously we were billing Z11.59 and this is what was causing denials, we would likely be switching to Z03.818 for asymptomatic exposure.
I would also GREATLY appreciate any links/articles on why this isn't ok if so, the more information I can get my hands on before giving a final answer the better.
Thank you