Results 1 to 4 of 4

Consult Code Denied

  1. #1
    Default Consult Code Denied
    Exam Training Packages
    Medicare just denied a Pre op consult 99244 for the date of service 12/15/09 stating "not covered under patient's current benefit plan". The appropriate diagnosis codes and referring doctors are documented. Has anyone ever heard of this?

  2. #2
    Default
    Hi - I would appeal this. It may well be that the system is not sensitive to the fact that at the time of service the consult code was still valid.
    I assume that you made sure all criteria for a consult and the level are supported by the documentation.
    Last edited by Karolina; 01-07-2010 at 01:36 PM. Reason: Premature submission
    Karolina, CPC, CPMA, CEMC

  3. #3
    Default
    I was thinking the same thing but wanted to be sure thanks!

  4. #4
    Default
    Another circumstance I have run into occasionally is if the patient has an outstanding liability claim (e.g. traffic accident), sometimes a particular diagnosis will trigger a rejection like this. Basically they are saying that for that particular dx, Medicare is not the responsible payer, but for other dx's they are. It doesn't happen often, but it's something to check out.
    Walker Bachman, CPC, CPPM

Similar Threads

  1. New patient code denied by Medicare
    By MACT1234 in forum Medicare Regulations
    Replies: 1
    Last Post: 09-11-2014, 06:31 AM
  2. Denied S5001 code
    By LaVoncye in forum OB/GYN
    Replies: 0
    Last Post: 05-16-2012, 08:38 AM
  3. Add on code denied
    By tholcomb in forum Dermatology
    Replies: 5
    Last Post: 01-16-2012, 11:36 AM
  4. consult code denied
    By coders_rock! in forum Cardiology
    Replies: 1
    Last Post: 08-30-2011, 03:40 PM
  5. Denied-lack of device code
    By codedog in forum Outpatient Facilities
    Replies: 1
    Last Post: 05-11-2010, 05:11 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.