Wiki Denial for CPT 37215 For Diagnosis Code

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mcauffman86

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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!!
 
Are those ICD-9 codes? Could you possibly use the bilateral services procedure with a 52 modifier?

Peace
?_?
 
I have not found out why yet. I actually have another denial today from Humana Medicare that I am working on. We used CPT 37215-RT with I65.21 which per the NCD spreadsheet, this is a covered dx code. I attached a copy of the link below for your reference as it may help with your denial as well. If I found out why these are denying, I will post the explanation. Let me know if you get some insight on this as well.


https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR9751.zip
 
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