Wiki help needed for 92587 denial

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Bamboo

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OAE(92587) was denied as "experimental". pt are younger than 5 yr, icd v20.2+v72.11, and 389.9 in some pt. How do we appeal?

Any advice would be greatly appreciated.

Bamboo:confused::
 
replay to 92587 problem

Hi I posted but couldn't get feedback; and whenever I log in i was told:"Invalid Thread specified. If you followed a valid link, please notify the administrator". what's wrong?
 
I see no problem with the post it may have been a glitch when you logged back in. I am having trouble understanding the visit as coded. You have a well child check , but alos are stating a prior failed hearing test and a hearing loss in the child? This is a little inconsistent and may be the problem. If the child has already had a well check and a hearing screening which showed a hearing loss then this visit should not be coded with the V20.2. If this is a normal screening of a well child then do not use the V72.11 or the 389.9. If you will notice in the ICD-9 book there is a code exclusion under V72. that states it excludes the V20.2 code. So it will help to know what the scenario is that you were coding, then you can submit a corrected claim. Just remember do not give the patient a dx they do not have just to get a cliam paid.
 
Thanks a lot Debra!:)

So v72 excludes the V20.2 code! However, in our cases, pt comes for well check including hearing screen, but the hearing test fails, so an OAE is performed. In such scenario can we add v72.11 to v20.2 and append a modifier like 59? would the claim still be denied no matter what because of the exclusiveness?

Bamboo :confused:
 
If the child fails the screening test you should probably then schedule the patient for the OAE for another day. One reason is because this is a child and you are putting the child through a lot on one day to do this all at once. Second is there are no exceptions to the exclusion. and 59 modifier does not apply to the dx codes. So probably the experimental part comes in with doing a screening and an OAE on the same day. Just a thought.
 
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