Jacoder
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I'm sorry if this is a duplicate thread. I searched the AAPC forum yesterday and couldn't find what I was looking for.
I work at a hospital. Recently my doctor ordered a PT/INR and PTT with the dx of "Pre-OP", nothing else. I knew this wouldn't cover it so I got the Dr to give me the surgury dx, which was Osteomyelitis of the toe. The patient is having her toe amputated. This still doesn't cover it according to Medicare. I talked to the doctor and he said that a surgan wouldn't touch a patient with out this test because they wouldn't know if the patient would bleed to death or not. It's necessary. So now I'm very frustraited because I can't find a way to get these paid and it seems like Medicare should cover this.
Does anyone have any advice on how to get PT/INR's paid for Pre-Op? Is an ABN the only solution? I'm to the point that I would almost try to appeal/ ask for a modification of medical necessity edits, but I don't think that is an option. If doctors are saying that this lab is absolutely necissary I just can't understand how Medicare can deny it. Thanks for your input.
I work at a hospital. Recently my doctor ordered a PT/INR and PTT with the dx of "Pre-OP", nothing else. I knew this wouldn't cover it so I got the Dr to give me the surgury dx, which was Osteomyelitis of the toe. The patient is having her toe amputated. This still doesn't cover it according to Medicare. I talked to the doctor and he said that a surgan wouldn't touch a patient with out this test because they wouldn't know if the patient would bleed to death or not. It's necessary. So now I'm very frustraited because I can't find a way to get these paid and it seems like Medicare should cover this.
Does anyone have any advice on how to get PT/INR's paid for Pre-Op? Is an ABN the only solution? I'm to the point that I would almost try to appeal/ ask for a modification of medical necessity edits, but I don't think that is an option. If doctors are saying that this lab is absolutely necissary I just can't understand how Medicare can deny it. Thanks for your input.