Medicare denials of pain management ESI's

[mns_princess@yahoo.com]

I have a lot of denials that just came back from Medicare on my pain management clinic and ESI's. The code range is 62320-62323. The denial states "these are non-covered services because this is not deemed a medical necessity." Has anyone else experienced this and/or what can I do to try to get them paid? Thank you.

 

[jkyles]

Hi there,
Epidurals without image guidance (62320, 62323) are not covered unless there's a "documented contraindication." If that applies to any of the patients you'll need to appeal. www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=39054&ver=5

For the ones performed with image guidance, I would start by checking the list of covered diagnosis codes in the companion coding/billing article.

diagnosis codes, diagnosis coding

 

[mns_princess@yahoo.com]

Thank you so much for your response. I’ll look into them some more.

diagnosis codes, diagnosis coding