Wiki Medicare denying N18.30 for nutritional services- Need help ASAP

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Does anyone know how to get Medicare to pay nutritional therapy (97802, 97803) when the patient has chronic kidney disease stage 3?

Recently, N18.3, Chronic kidney disease stage 3, has been deemed an unbillable code. The available codes to replace N18.3 are N18.30, N18.31, and N18.32. In the past, we would use N18.3 and it would get paid by MDC. We've been using N18.30 (CKD stage 3, unspecified) to use for nutritional therapy on our Medicare patients. Medicare is now denying N18.30. Can someone please advise?
 
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What is the specific denial?

Are they eligible? Meaning, have they used their yearly benefit already?
The denial is: CO-50 : These are non-covered services because this is not deemed a 'medical necessity' by the payer.

Yes, they are eligible. The issue seems to be the ICD 10 code. I've spoken to a Medicare rep and the rep stated the denial is for the diagnosis code. I was unable to obtain anymore specific information from the rep.
 
I believe they are looking for a comorbidity diagnosis code. They want to know what is causing his/her Chronic Kidney disease. Do they have diabetes or hypertension etc. According to my ICD-10 coding manual, an N18 not only requires a fourth digit but you must code first any underlying condition.Diabetic chronic kidney disease would be in the E08.22, E09.22,E10.22,E11.22 or E13.22.Hypertensive chronic kidney disease would be I12-,I13-.
If that doesn't work with adding the reason for the chronic kidney disease first and the chronic kidney disease second then Medicare may have a glitch.
Good luck!
Davieda Skobel CLPN,CPC
Columbus Ohio
 
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Does anyone know how to get Medicare to pay nutritional therapy (97802, 97803) when the patient has chronic kidney disease stage 3?

Recently, N18.3, Chronic kidney disease stage 3, has been deemed an unbillable code. The available codes to replace N18.3 are N18.30, N18.31, and N18.32. In the past, we would use N18.3 and it would get paid by MDC. We've been using N18.30 (CKD stage 3, unspecified) to use for nutritional therapy on our Medicare patients. Medicare is now denying N18.30. Can someone please advise?
Hi,
I believe it's because N18.30 is an unspecified dx and not included on the Medicare NCD, see attached. I hope this helps!
Danielle
 

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  • Copy of 180.1 MNT 102120 ba.pdf
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