Question LCD/NCD Code pair check failed

khix94

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OP Hospital Crisis Unit
Medicare AB
90795 - Psych Eval
DX: Z03.89 Z63.0 Z65.8
Message: LCD/NCD code pair check failed online item 1 (90792) for J6 NGS policy nbr (s) L33626, L33632, please review policy numbers for applicable diagnosis codes.


Does anyone have any guidance for this? I am working coding edits that will not go out the door and do not understand this and how to fix it. Thanks!!!
 

b.cobuzzi

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90795 is a deleted code. I am not sure what you are trying to bill. What diagnoses are you trying to bill with 90792?
 

khix94

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Whoops it is CPT 90792. not 90795

Pro Care 1500
CPT 90792
DX: Z03.89 - Encounter for observation for other suspected diseases and conditions ruled out
Z63.0 - Problems in relationship with spouse or partner
Z65.8 - Other specified problems related to psychosocial circumstances
 

b.cobuzzi

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I believe you are getting the error because you are using all Z codes. Did you go onto the NGS website to see if there is a NCD or LCD for this CPT code, which defines the ICD10 codes that are payable for 90792?
 

thomas7331

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I agree, the error is due to the diagnosis codes. I would guess this is coded incorrectly because Z03.89 - for a 'suspected' condition ruled out, is likely incorrect. Psychiatric diagnostic evaluations are not typically performed for 'suspected' conditions, but because the patient presents an actual complaint, symptom or problem. Start by reviewing your documentation, and then check the codes against the coverage information in the NGS LCD.
 
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