Echo Denials

renifejn

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I recently received a list of denials (thankfully very, very short) and was asked to determine the reasoning. In the echo report, there were no findings--everything was normal. The "reason for test" is "evaluation of left ventricle function" or r/o "pericardial effusion", etc. The ICD-9 code used was V81.2 and this is being denied every time for inpatient visits.

Also some reports only say VSD s/p repair so V15.1 is being coded along with V81.2.

Does anyone have any suggestions on what code to use? Referral diagnosis is listed, but sometimes one is given such as leukemia and that isnt a payable dx for an echo.

HELP!

Thanks
 

ARCPC9491

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are there any signs and/or symptoms that can be coded? i.e. chest pain, a fib... there has to be some reason why they are evaluating ventricular function... and wanting to rule out an effusion
 

renifejn

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no signs/symptoms to help out....

some pts have "baseline echo prior to chemo", "rhabdomyosarcoma vs leukemia; elvaluate for mass", and some with "VSD s/p repair" as referral diagnoses. Then the reason for the test states assess cardiac function, etc.
 

dclark7

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Are these medicare claims, and if so do you happen to have NGS as your medicare carrier? If so, we are having the same problem. According to LCD #L28169, V81.2 is a valid ICD code for the echo, but they are getting denied anyway. We've been tracking the denials and appealing them, no response yet to our appeals.

Doreen, CPC
 

dclark7

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Some commercial insurance only allow certain ICD codes with echos. They (especially Aetna) will not pay because they consider the use of echos for any reason other than their established codes to be experimental. You can get the policies from most insurance co. websites and the policy will list ICD codes that are usable.

Doreen, CPC
 

AGRIFF30

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It sounds as though you're going to have to appeal w/ notes for those denied claims. That's what I've been doing and the insurances have been paying. The one I do have difficulty with is Aetna. Aetna was paying my appeals but for the last month or so, they haven't.
 
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