Noridian Medicare denial

daedolos

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Long Beach
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I've been assigned research on a claim denial for reason code "CO-50" = non-covered services not deemed necessity by payer.

Patient came in for neck pain and doctor examined and applied trigger point injection in the posterior aspect of the neck then prescribed physical therapy. However, the patient was also there to review MRI for previous knee ailment.

The Diagnosis pointer for CPT code 20552 was M62.838. This was assessed the CO-50 reason code. What can I do to bounce this back with a payment on claim?

Peace
@_*
 

ncurtis

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Bend Oregon Central Oregon
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I've been assigned research on a claim denial for reason code "CO-50" = non-covered services not deemed necessity by payer.

Patient came in for neck pain and doctor examined and applied trigger point injection in the posterior aspect of the neck then prescribed physical therapy. However, the patient was also there to review MRI for previous knee ailment.

The Diagnosis pointer for CPT code 20552 was M62.838. This was assessed the CO-50 reason code. What can I do to bounce this back with a payment on claim?

Peace
@_*
Have you taken a look at the LCD on CPT code 20552? https://med.noridianmedicare.com/do...ination+for+Trigger+Point+Injections+(L34211)

M62.838 other muscle spasms is not a covered diagnosis according to the LCD.
Does the supporting documentation list any other diagnosis codes? If not, did someone obtain an ABN? If you are unable to find another diagnosis and an ABN wasn't obtain then you may have to write off the charge since the CO- Means you are contractually obligated to write it off.
 
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