mcauffman86
Networker
We have been receiving denials on CPT 37215 from Medicare for the diagnosis code. We can't quite figure out what the issue is. We billed CPT 37215 with modifier RT and appended the diagnosis codes I65.21. Does anyone have any info on this? I have spent hours trying to figure out what is the issue and when I look at the Medicare transmittals and look at the NCD 20.7 spreadsheets, dx code I65.21 is listed. My co-workers were under the assumption that 2 dx codes needed to be on this code so they added I65.29 which contradicts with I65.21 since I65.29 is an unspecified code but it seems to pay when they do this through a redetermination?? They were going by this excerpt from the Medicare transmittal: "To correctly bill covered bilateral carotid services, providers can code both 433.30 or 433.31 and 433.10
or 433.11 in any order on the same claim. Code 433.30 with 433.10 or 433.31 with 433.11 to identify the
multiple and bilateral condition and 433.10 or 433.11 to specifically identify the carotid artery."
But I believe that they are interpreting this incorrectly. This states for a bilateral condition. The patient we are billing for did not have bilateral stenosis.
Please help!!
or 433.11 in any order on the same claim. Code 433.30 with 433.10 or 433.31 with 433.11 to identify the
multiple and bilateral condition and 433.10 or 433.11 to specifically identify the carotid artery."
But I believe that they are interpreting this incorrectly. This states for a bilateral condition. The patient we are billing for did not have bilateral stenosis.
Please help!!
diagnosis codes, diagnosis coding