xxxZithxxx
New
Recently had a TSH denied by Medicare. It was a repeat test - the original was performed Feb and the repeat was April.
The MD used ICD10 code E78.2 for the second test, but the progress note states it is because the first results were slightly elevated ( 4.84mlU/l with a range of 0.40 - 4.50mlU/L)
Trying to figure out what other information could be submitted to help this be paid.
Patient has hyperlipidemia (controlled), rheumatoid arthritis unspecified, CAD & HTN. Patient is on Rx for the RA.
No history regarding thyroid goiter, hyper or hypothyroidism, diabetes.
Per: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=101
Limitations
"Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted." (Granted, the patient could have had testing via another MD at some point as well...)
We are NOT the patient's PCP. Our MD sees PT for ASCAD.
Is there anything we can do to resubmit this lab for payment, so the patient isn't saddled with the fee?
TYIA.
The MD used ICD10 code E78.2 for the second test, but the progress note states it is because the first results were slightly elevated ( 4.84mlU/l with a range of 0.40 - 4.50mlU/L)
Trying to figure out what other information could be submitted to help this be paid.
Patient has hyperlipidemia (controlled), rheumatoid arthritis unspecified, CAD & HTN. Patient is on Rx for the RA.
No history regarding thyroid goiter, hyper or hypothyroidism, diabetes.
Per: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=101
Limitations
"Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted." (Granted, the patient could have had testing via another MD at some point as well...)
We are NOT the patient's PCP. Our MD sees PT for ASCAD.
Is there anything we can do to resubmit this lab for payment, so the patient isn't saddled with the fee?
TYIA.