Wiki Medicare denial of 57423

[ecushing]

Saying code not recognized by Medicare.... .

 

[csperoni]

57423 Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach is a current valid code and should be recognized by all MACs. I'm guessing either:
1) The denial is not really for the CPT code. Maybe the diagnosis doesn't match, or there is an NCCI edit with another code used.
2) The MAC made an error.
What was the exact denial?

 

[ecushing]

57423 Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach is a current valid code and should be recognized by all MACs. I'm guessing either:
1) The denial is not really for the CPT code. Maybe the diagnosis doesn't match, or there is an NCCI edit with another code used.
2) The MAC made an error.
What was the exact denial?

It states (reason code 0) that payment is not allowed because the procedure code billed is not recognized by medicare, and a corrected claim can be submitted with a valid medicare code for payment.

 

[csperoni]

It states (reason code 0) that payment is not allowed because the procedure code billed is not recognized by medicare, and a corrected claim can be submitted with a valid medicare code for payment.

I would call my MAC and speak with a human regarding the denial. If this was the only CPT billed with no modifiers, then I think they made an error and perhaps could provide more guidance.
With my local MAC, a denial would generate a claim denial code with letters and numbers. Like PR27 or MA83 - something like that which is standardized. I never heard of reason code 0.