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Thread: Medicare denying rheumatology diagnosis

  1. #1
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    Default Medicare denying rheumatology diagnosis

    We are having a problem with Medicare denying our Rheumatoid arthritis diagnosis (714.0) as a auto accident injury. We have contacted Medicare twice and have not received any help regarding this. Is anyone else having this problem? I would understand if this was just on one patient, but we have about 4 with the same problem. I was thinking maybe it is an edit in their system. Any suggestions?

  2. #2
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    All I can think of is that you may have the indicator on the CMS claim form for accident as a yes instead of no? We have four Rheumatologists and have not had this problem. Or, does Medicare have on file that these particular patients have auto liability primary for some accident and haven't updated their records? I wish I could be more help.

  3. #3
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    I have a question. Why would you use 714.0 for an auto accident? I would use an injury code first, and if the patient happens to have rheumatoid arthritis code that after the injury code(s).
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    I will check to see if any of our patients have the incorrect indicator or if they have had any accident claims recently. I appreciate your help, I hope we can fix this problem quickly. Thank you again.

  5. #5
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    Quote Originally Posted by Lisa Curtis View Post
    I have a question. Why would you use 714.0 for an auto accident? I would use an injury code first, and if the patient happens to have rheumatoid arthritis code that after the injury code(s).
    Medicare is denying the claims as accident related. According to the patients the visits were not accident related.

  6. #6
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    Quote Originally Posted by Lisa Curtis View Post
    I have a question. Why would you use 714.0 for an auto accident? I would use an injury code first, and if the patient happens to have rheumatoid arthritis code that after the injury code(s).
    The Medicare customer service rep stated the claims were being denyed because of the diagnosis being accident related. We know that the 714.0 is not an accident injury diagnosis, but they want us to change it or file to the auto insurance. That is why I was wondering if anyone else was having a problem, because this has never happend to us before with our Rheumatology diagnosis codes.

  7. #7
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    Wow! Who is your Medicare carrier? 714.0, rheumatoid arthritis, is an auto-immune disorder, not an auto accident! There is definitely something wrong with their edit. I would call them again and ask for a supervisor. Hopefully they haven't started denying all auto-immune disorders as accident related.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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