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Wiki Medicare Denial - We have a patient who presented

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kristy2

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We have a patient who presented for pain in the gum line. The NP that saw her did an exam and noted a lesion on the gum line. The NP referred her to follow up with her dentist. We sent the claim to Medicare, and of course they denied because of the dental diagnosis. Is there anyway we can code this accuratly to get Medicare to allow the office visit?
 
If there's a trick to this I would like to know also! I've never had any luck getting Medicare to pay a claim with primary diagnosis as dental.
 
If the documentation could support it...maybe a code from the neoplasm table? If not...

As indicated under the general exclusions from coverage, items and services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth are not covered. “Structures directly supporting the teeth” means the periodontium, which includes the gingivae, dentogingival junction, periodontal membrane, cementum of the teeth, and alveolar process

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

Section 150
 
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