Wiki Receiving Lab denials from UHC when using Z codes

[jbooklover]

Hello! I have been noticing an issue with United HealthCare where they are denying our lab claims for medical necessity if the first dx is a Z code. The lab charges vary but I tend to see that a lot of the time labs such as CBB w/ dif, Lipid panel, and Hemoglobin A1C are the ones being denied. Has anyone else had this issue and found a way to avoid or overturn the denials?

Thank you!

 

[fwnewbie]

Isn't it be outlined in the UHC contract what they will/won't take for medical necessity? Do you have more experienced coders in your group that can guide you?

 

[mnuhfer04]

I’ve noticed that most insurances that we work with will only pay for labs that have a dx attached to it and will deny for z codes

 

[trarut]

Hello! I have been noticing an issue with United HealthCare where they are denying our lab claims for medical necessity if the first dx is a Z code. The lab charges vary but I tend to see that a lot of the time labs such as CBB w/ dif, Lipid panel, and Hemoglobin A1C are the ones being denied. Has anyone else had this issue and found a way to avoid or overturn the denials?

Thank you!

Have you gone to the UHC provider website and looked for any policies related to the lab tests in question? Those will usually guide you in terms of medical necessity for the services.