Wiki Procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892

[GMMTimmons]

"Per LCD or NCD guidelines, procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892"
This is the denial received for an AARP Medicare Complete plan where we billed out:

99214-25
64490-50
DX code M47.812

Can someone explain this denial please? Is this due to the office and procedure having the same DX code. The office visit should not have been billed since there was no significant or separate issue, but I want to make sure I understand the denial mentioned above.
Thanks in advance!

 

[Melissa Harris CPC]

I would call contact the insurance. Not sure what this denial means. Maybe they want LT/RT instead of 50?

 

[jkyles]

The ONLY thing I can think of is that under the new LCDs diagnostic blocks must be reported with modifier KX. Therapeutic blocks are denied and must be appealed to show why RFA wasn't appropriate for the patient.

 

[GMMTimmons]

The ONLY thing I can think of is that under the new LCDs diagnostic blocks must be reported with modifier KX. Therapeutic blocks are denied and must be appealed to show why RFA wasn't appropriate for the patient.

I forgot to add the KX to my example. We did bill it with modifier KX. I've contacted the insurance and their reps can't seem to answer the question either. grrrr, Still working on getting this resolved.