Wiki Cpt 90281

Timothy S

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Hi Everyone, need help on this one.

Medicare denied the CPT 90281 with Dx 794.31 as Procedure/treatment is deemed experimental/investigational by the payer and we are unable to find other Dx in the medical records except V70.0.
 
Hi Everyone, need help on this one.

Medicare denied the CPT 90281 with Dx 794.31 as Procedure/treatment is deemed experimental/investigational by the payer and we are unable to find other Dx in the medical records except V70.0.

I don't know if this will help you but when we bill TAVR's we have to append a V70.7 (Exam of participant in clinical trial) as a second diagnosis. Good luck :)

You may also want to look at modifier Q0 (Investigational clinical service provided in in a clinical research study that is in an approved clinical research study)
 
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To better address the question it would be interesting to to see the note in this case. Your dx code is an abnormal EKG, and you have a code for IM immunoglobulin. what did the provider document as the need for the immunoglobulin, it was not just because of an abnormal EKG.
 
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