ashae17
Guest
I have an office visit (CPT 99213-24) denying as "service is inconsistent with the patient's history". The dx is cervicalgia M54.2
The patient came in for a follow up visit following carpal tunnel release procedure, and the other issue addressed was cervicalgia. For this portion of the eval, Cervical MRI was reviewed, where the only pertinent finding was "Straightening of cervical lordosis may be positional or related to diffuse muscle spasm." The doctor didn't diagnose any condition and still referred to cervicalgia in the assessment. The MDM involved activity modification and medical management, neurology referral.
It is documented throughout the report that cervicalgia was being addressed in contrast to the normal post op appointment. An appeal was submitted with denial upheld. Is there something I'm missing here? This is not a denial for E/M level, they seem to be missing the reason the established visit was billed. Is there another dx that should be primary on the charge? Z47.89 secondary? Thanks for any help.
The patient came in for a follow up visit following carpal tunnel release procedure, and the other issue addressed was cervicalgia. For this portion of the eval, Cervical MRI was reviewed, where the only pertinent finding was "Straightening of cervical lordosis may be positional or related to diffuse muscle spasm." The doctor didn't diagnose any condition and still referred to cervicalgia in the assessment. The MDM involved activity modification and medical management, neurology referral.
It is documented throughout the report that cervicalgia was being addressed in contrast to the normal post op appointment. An appeal was submitted with denial upheld. Is there something I'm missing here? This is not a denial for E/M level, they seem to be missing the reason the established visit was billed. Is there another dx that should be primary on the charge? Z47.89 secondary? Thanks for any help.
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