Wiki Medicare Denial

[csrigney26@outlook]

I received a Medicare denial for GPT G0420 with a diagnosis code of N18.5. Per the remittance the allowance was $273.50 but did not pay using denial code of co-167. Can I use the G0420 with an E/M code of 99214 for same date of service?

 

[csperoni]

While I don't personally bill this service, CO-167 is diagnosis not covered. I would recommend checking if there is an LCD/NCD for your procedure.
You cannot use G0420 along with 99214 to describe the SAME work. You may use them together IF there was a level 4 established visit and then a separate G0420. There is no NCCI edit.

 

[Elliewl]

Where I work, we frequently bill G0420. According to the Medicare Benefit Policy Manual, Chapter 15, Pg. 263. Medicare covers G0420 with the diagnosis code N18.4. This may be the cause of the denial.

 

[sls314]

Medicare's benefit for Kidney Disease Education is for Stage 4 CKD. https://www.medicare.gov/coverage/kidney-disease-education

Since you're billing it for Stage 5 CKD, that's why you're getting the CO-167 diagnosis not covered denial.