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mitchellde
True Blue
The dx code is unspecified which could be the reason, also DOS for this code must be prior to 10/01/15.
TonyaMichelle
Guru
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Maybe the carrier has a policy preventing the payment, other than that I don't see why it was denied. The diagnosis is cross walked with the procedure, unless the procedure was billed with a column 2. Also, I agree with Debra that the DOS for the code should be prior to 10/1/2015 due to ICD-10 being implemented.
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CodingKing
True Blue
I thought I had replied but must have been filtered out to a link I posted. First thought as above was is this DOS prior to 10/1 due to the diagnosis. The other issue is were other services billed the same day by providers in the same group. I had found a nice link from Optum discussing this code and clinical edits. One example is this cannot be billed with therapy on the same day as the eval