Wiki Humana denial of unattended sleep study

[d__livingston@hotmail.com]

I need help!! Humana has denied several claims for the diagnosis is inconsistent with the procedure. The procedure code is 95806 and the diagnosis code is G47.8. We've even billed procedure code G0399 and it was denied. Is it that the dx code is not specific enough??? Humana can't help me, the CSR's just read the denial reason. Has anyone else had this issue?? I am new to billing but this issue even has our coders confused. Thanks in advance

 

[SharonCollachi]

Have you read their policy on sleep studies? Go here and look for "sleep studies, adult": http://apps.humana.com/tad/tad_new/Search.aspx?criteria=sleep&searchtype=freetext&policyType=both

A cursory glance at the policy looks like it might need a cardiac diagnosis as well.