Wiki Cpt 85018 - E/M to Medicare

[JRC]

Hi,

We have billed CPT 85018 with an office E/M to Medicare,
we received payment for E/M but CPT 85018 was denied as not covered.

Can anyone help me to get this claim paid.

Thank You
JRC

 

[zulkos]

Apending a 25 Mfr to the e/m.

 

[kbarron]

Did you use the QW modifier?

 

[JRC]

Yes Karen we used QW on CPT 85018

 

[tanyaharberts]

What dx was linked?

 

[JRC]

280.9 was the dx used

 

[tanyaharberts]

I would appeal. 280.9 (Iron deficiency anemia, unspecified) should be covered for 85018 (Hemoglobin). It is not listed in either the non-covered diagnosis section or the medical necessity section of NCD 190.15 (Blood Counts). Refer to this NCD at:
http://www.cms.hhs.gov/CoverageGenInfo/downloads/manual200910.pdf#4

 

[JRC]

Thank You

 

[CMHOULE]

cmhoule

can you tell me if modifier 26 must be appended to the 85018 ?

thanks