Wiki Denial For 37215 Need Advice!

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suziap

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Hey fellow coders-
Insurance ( a small commercial type) is denying 37215 for experimental/investigational.
Has anyone run across this before?
I am gathering the all the patient's previous exams etc to show that the procedure was warranted but any advice you have sure would be appreciated!

Suzi
 
In my experience when an insurance company denies a procedure code for "experimental/investigational" it is because of the diagnosis. I would check with the insurance to see if they have a list of diagnosis that are covered for that procedure. Hope that helps!
 
Carotid Stents

:( My biggest issue right now is with Medicare Part B of Florida. They are rejecting everything we send and all for a different reason. They have even rejected it for "place of service." Has anyone in Florida comes across this issue?

Jeannie Randhan, CPC
MID-FLORIDA CARDIOLOGY SPECIALISTS
 
With Carotid stents the place of service does have to be an inpatient and your facility must be an approved facility to perform the procedure. The only dx on the Medicare Fee schedule is 433.10.
 
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