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G0166-External Counterpulsation

  1. #1
    Default G0166-External Counterpulsation
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    Hi All,

    We billed G0166 with dx 413.9 but Medicare denied the claim as "Not medically necessary". Per LCD 28258 413.9 is the only dx covered.
    Can anyone help me in this?

    Thanks,
    JRC CPC

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by JRC View Post
    Hi All,

    We billed G0166 with dx 413.9 but Medicare denied the claim as "Not medically necessary". Per LCD 28258 413.9 is the only dx covered.
    Can anyone help me in this?

    Thanks,
    JRC CPC
    This code has a ASC payment indicator of IN-Nonsurgical procedure not Medicare allowable in an ASC. Which means it is a hospital inpatient only procedure. Perhaps that is the problem.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Default
    ^ No this should be paid for while at the office. This should not have been denied unless the criteria has not been met. I would appeal it with office notes to show no other course of action can be taken and ECP is the only treatment.
    Last edited by ERIC_MPB; 09-14-2009 at 11:26 AM. Reason: *Spelling :)

  4. #4
    Default G0166
    yes this can be paid for when done in the office you need to appeal with notes and a letter of med/necessity from your dr.

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