Wiki Physical Therapy - G0283GP denying because of LCD L37642

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kamile01

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Hello, we continue to receive denials form Palmetto for G0283GP with the explanations below. Per call to Medicare, LCD L37642 (Nerve Blocks and Electrostimulation for Peripheral Neuropathy) prompted the denial for G0283. Question: Why wouldn’t LCD L34428 (Outpatient Physical Therapy) apply to GO283GP instead of L37642?

DOS 4/2/18, Loc 11
97110GP, 97530GP, G0283GP
DX - M25611 R531 M79621 M25511

50 These are non-covered services because this is not deemed a 'medical necessity' by the payer
M25 The information furnished does not substantiate the need for this level of service
N115 This decision was based on a Local Coverage Determination (LCD)

Thanks, Karen
 
G0283gp denying

What you need to do is submit a corrected claim and apply your dx pointer on dx code m25111. This is telling the carrier this particular dx code is supportive for the treatment
 
Following...G0283 Denial

I am having the same problems with getting this code paid. They explained that we had to go off of the LCD 37642. If you look at those allowed diagnosis there aren't any M25.xxx codes listed. Have you resolved this problem and are getting paid now? If so, could you please tell me what you did? I tried pointing the Dx to codes like pain in shoulder,etc. but it is still denying for invalid diagnosis.

Thank you,

Sarah
 
From LCD L37642 regarding G0283

Group 2 Paragraph:
Note: Use of the following Physical Medicine and Rehabilitation CPT/HCPCS Codes for these treatments is inappropriate:
Group 2 Codes:
CODE DESCRIPTION
97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281
G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE.

The above is fine but we bill for PT-LCD L34428, not nueromusclar-LCD L37642. Claims should fall to the Outpatient Physical Therapy LCD instead of Neuromuscular LCD. In other words, there are at least 2 (or more) LCDs that are prompted by G0283, but only one of those is for outpatient physical therapy.
 
WHAT ICD-10 CODES CAN WE USE TO GET THE G0283 TO PAY? I CANNOT GET THE MEDICARE SITE TO WORK THAT YOU CAN PLUG THEM IN TO CHECK TO SEE IF IT WILL PAY?
 
kamile01 said:
From LCD L37642 regarding G0283

Group 2 Paragraph:
Note: Use of the following Physical Medicine and Rehabilitation CPT/HCPCS Codes for these treatments is inappropriate:
Group 2 Codes:
CODE DESCRIPTION
97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281
G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE.

The above is fine but we bill for PT-LCD L34428, not nueromusclar-LCD L37642. Claims should fall to the Outpatient Physical Therapy LCD instead of Neuromuscular LCD. In other words, there are at least 2 (or more) LCDs that are prompted by G0283, but only one of those is for outpatient physical therapy.
Click to expand...

HOW DO I BILL FOR THE LC4428? SORRY I AM LOST ON THIS
 
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