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83036 A1c denials

  1. #1
    Location
    Jackson, TN
    Posts
    77
    Default 83036 A1c denials
    Medical Coding Books
    We are a family practice medical facility and we all of a SUDDEN received denials for 83036 which is checking the A1c. Has anyone else had a similar problem. The denials date back to 06,28.2011 that is when the denials started. Most of these have been 3 months or more from the last time 83036 was just to check the a1c. Any suggestions?

  2. #2
    Smile 83036 A1c denials
    Dont forget that it is all about the insurance companies. if you are getting denials on 83036 try 83037-qw. Hey I just thought of something, are you adding the QW modifier to your 83036, if not add it and you might just get paid.
    [I]Elizabeth Comma-Watson, CPC
    Billing/Coding Specialist
    Greensboro, NC 27455-2601

  3. #3
    Location
    Jackson, TN
    Posts
    77
    Default
    Hey- yes we are appending the QW to the 83036

  4. #4
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    We are getting these denials also. We bill the 83036 with a qw. I did some research and this is only payable every 3 months for most patients. Our schedulers have been making appts. 3 months out to the day so we changed that. I believe the documentation is in the LCD for CLIA lab tests.

  5. #5
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    By the way, it seems only to be an issue with Medicare.

  6. #6
    Location
    Jackson, TN
    Posts
    77
    Default
    yES Medicare is only one.. what are you doing different to fix this?

  7. #7
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    Scheduling patients for these services greater than 3 months from the last.

  8. #8
    Location
    Jackson, TN
    Posts
    77
    Default
    I mean are you refiling any of them?

  9. #9
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    We tried to appeal them but they got denied. Let me know if you have any luck getting yours paid!

  10. #10
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    I wanted to let you know that we have had some luck appealing these. Patients that have "uncontrolled" dm are allowed to have their A1C's more freq. We have looked at some of these records and got some of these paid by appealing with notes!

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