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Denial For 37215 Need Advice!

  1. #1
    Default Denial For 37215 Need Advice!
    Medical Coding Books
    Hey fellow coders-
    Insurance ( a small commercial type) is denying 37215 for experimental/investigational.
    Has anyone run across this before?
    I am gathering the all the patient's previous exams etc to show that the procedure was warranted but any advice you have sure would be appreciated!


  2. #2
    In my experience when an insurance company denies a procedure code for "experimental/investigational" it is because of the diagnosis. I would check with the insurance to see if they have a list of diagnosis that are covered for that procedure. Hope that helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. Angry Carotid Stents
    My biggest issue right now is with Medicare Part B of Florida. They are rejecting everything we send and all for a different reason. They have even rejected it for "place of service." Has anyone in Florida comes across this issue?

    Jeannie Randhan, CPC

  4. #4
    With Carotid stents the place of service does have to be an inpatient and your facility must be an approved facility to perform the procedure. The only dx on the Medicare Fee schedule is 433.10.

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