Ct scan of Neck w/ contrast

[mbcstudent]

Medicaid denials for legit dx--PLZ HELP!

Does anyone know why Medicaid would deny CPT 70491 (Ct scan of Neck w/ contrast) for dx code 7231 (neck pain)? Is anyone else having this problem? Any idea how to fix it? Thanks

 

[donnajrichmond]

it's probably a diagnosis code/procedure code mismatch
70491 is soft tissue of the neck while 723.1 is intended for pain in the/caused by cervical spine.

if this was CT soft tissue of the neck, you probably want 784.1 for a diagnosis
or
if this was CT of the cervical spine, then 723.1 would be appropriate.

(of course, it all depends on what was really ordered, done, and documented).

Donna J Richmond