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Wiki Verteporfin for CSR

S

Stenglein

Networker
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28
Location
Frankenmuth, MI
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I have a patient who received PDT treatment with verteporfin for retinal neovscularization secondary to central serous chorioretinopathy. Per WPS (our local mac), CSR is covered as of 1/1/2016 and I see it in L34741 (retired) and the procedure 67221. However, the insurance (which is a medicare advantage plan) keeps referencing document 80.3 issued in 2014 with the implementation of ICD-10. This discusses AMD and others the patient does not have. We have appealed this several times and each time are denied with the last denial referencing this 80.3 document. Has anyone else run into this issue and how was it resolved?
 
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