Wiki Help needed for OAE and others

[Bamboo]

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

2. Wellcare rejects claims for vaccinations with both hepA & hepB (90633+90744), since they share the same icd code V05.3. The claims were rejected by the system as "duplicate Dx codes".

Any advice and suggestion will be greatly appreciated.

Bamboo

 

[gagnonangela]

The denial you are getting from AGP is due to the diagnosis code that is being billed with the 92587. You need to contact AGP and ask for a CPB in regards to evoked potential studies.

 

[Bamboo]

thanks gagnonangela, for your help! I thought I had replied, but realized only now I haven't.
Bamboo