mainella@umich.edu
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Working rejection. In this case the patient is receiving xolair injections (high dollar). Per LCD they will reimburse for the more specific asthma 493.00 as opposed to the unspecified 493.90 which we assigned.
Dates of service rejected are 9/21/12, 3/22/13, 4/5/13 and 4/19/13. In reading all documentation they do not consistently specify the more specific asthma, 493.00. The first mention of extrinsic asthma was 12/15/10 and then in the notes for 7/25/12, 10/24/12 and 9/23/13. The rest of the notes refer to the unspecified 493.90.
Would you stretch and change the dx to 493.00 on the rejected claims since it was mentioned? Would you leave it as 493.90 because the more specific asthma wasn't mentioned on the dates of service rejected?
Dates of service rejected are 9/21/12, 3/22/13, 4/5/13 and 4/19/13. In reading all documentation they do not consistently specify the more specific asthma, 493.00. The first mention of extrinsic asthma was 12/15/10 and then in the notes for 7/25/12, 10/24/12 and 9/23/13. The rest of the notes refer to the unspecified 493.90.
Would you stretch and change the dx to 493.00 on the rejected claims since it was mentioned? Would you leave it as 493.90 because the more specific asthma wasn't mentioned on the dates of service rejected?