Results 1 to 4 of 4

Help!!!-Humana is denying

  1. Default Help!!!-Humana is denying
    Exam Training Packages
    Humana is denying code 93880 based on Medicare LCD's, and the hospital is billing with dx 298.9. Can this be changed?
    Also, code 93306 is being denied because it can't be billed as outpatient and I'm not sure why.

    Clinical History: Confusion, dizziness.

    Technique: Multiplanar, multiecho and spin-echo imaging of the brain was performed utilizing standard pulse sequence. Axial FLAIR, T2 and diffusion-weighted pulse sequences were obtained as well as axial gradient-echo and sagittal T1- weighted pulse sequence.
    In the right periventricular white matter, there is an approximately 1.3 cm area of decreased signal within the white matter. On the same image slice located laterally, there is a gray-matter abnormality measuring approximately 2.2 cm in width. An additional 2.3 cm abnormal focus of increased signal in the right periatrial region is noted. On the T1-weighted pulse sequences, this has some increased signal suggesting at least a small amount of hemorrhagic inversion. No shift of the midline structures. No signficant mass effect.
    There is flow void in the itnernal carotid arteries and basilar artery. Seventh and eighth nerve complexes appear normal.

    Impressionl: Abnormal signal in the right cerebral hemisphere raises the possiblity of embolic type infarcts. At least some component of hemmorrhage in the right periatrial region. Cannot completely exclude the possibility of metastatic disease.

    So then he got a Carotid Duplex Scan
    History: Dizziness
    Findings: Gray-scale and color duplex exam of the carotids performed

    There is mild intimal wall thickening of the common carotid arteries bilaterally. Minimal atheromatous plaque involving the carotid bulbs. Antegrade flow in the vertebrals.

    Peak systoclic velocity left common carotid artery 106.6cm/sec and within the left itnernal carotid artery 87.3 cm/sec. Peak systolic velocity in the right common carotid artery 85.9 cm.sec and within the right internal carotid artery 34.4 cm/sec.

    Impression: Atheromatous plaque in the carotid bulbs and mild intimal wall thickenig of the common carotid arteries but no elevated velocities to suggest hemodynamically significant stenosis.

    Any help would be appreaciated!!!

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by clarkin15 View Post
    Humana is denying code 93880 based on Medicare LCD's, and the hospital is billing with dx 298.9. Can this be changed?
    Also, code 93306 is being denied because it can't be billed as outpatient and I'm not sure why.

    Clinical History: Confusion, dizziness.

    Technique: Multiplanar, multiecho and spin-echo imaging of the brain was performed utilizing standard pulse sequence. Axial FLAIR, T2 and diffusion-weighted pulse sequences were obtained as well as axial gradient-echo and sagittal T1- weighted pulse sequence.
    In the right periventricular white matter, there is an approximately 1.3 cm area of decreased signal within the white matter. On the same image slice located laterally, there is a gray-matter abnormality measuring approximately 2.2 cm in width. An additional 2.3 cm abnormal focus of increased signal in the right periatrial region is noted. On the T1-weighted pulse sequences, this has some increased signal suggesting at least a small amount of hemorrhagic inversion. No shift of the midline structures. No signficant mass effect.
    There is flow void in the itnernal carotid arteries and basilar artery. Seventh and eighth nerve complexes appear normal.

    Impressionl: Abnormal signal in the right cerebral hemisphere raises the possiblity of embolic type infarcts. At least some component of hemmorrhage in the right periatrial region. Cannot completely exclude the possibility of metastatic disease.

    So then he got a Carotid Duplex Scan
    History: Dizziness
    Findings: Gray-scale and color duplex exam of the carotids performed

    There is mild intimal wall thickening of the common carotid arteries bilaterally. Minimal atheromatous plaque involving the carotid bulbs. Antegrade flow in the vertebrals.

    Peak systoclic velocity left common carotid artery 106.6cm/sec and within the left itnernal carotid artery 87.3 cm/sec. Peak systolic velocity in the right common carotid artery 85.9 cm.sec and within the right internal carotid artery 34.4 cm/sec.

    Impression: Atheromatous plaque in the carotid bulbs and mild intimal wall thickenig of the common carotid arteries but no elevated velocities to suggest hemodynamically significant stenosis.

    Any help would be appreaciated!!!
    First, need to know what area of the country you are in since LCDs are regional and can be different. The 298.9 is definitely a problem as a dx with that scan, there are specific dx codes that are allowed by Medicare for it. You would need to talk to someone in the hospital coding department to find out why they are using that code vs. one that would reflect what is in the documentation.

    Second I don't know why 93306 would be denied due to outpatient POS. Was the Echocardiography done outpatient at the hospital? Or was it at a radiology office or in the physician office? Need a bit more info....
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    The hospital is in Colorado. I agree, I don't think 298.9 should be used, I just wanted a second opinion. Also yes, the 93306 was done outpatient at the hospital.

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by clarkin15 View Post
    The hospital is in Colorado. I agree, I don't think 298.9 should be used, I just wanted a second opinion. Also yes, the 93306 was done outpatient at the hospital.
    I think the problem with the 93306 may be related to a dx code rather than the POS. This procedure code is allowed in the out patient setting...recheck dx codes for both procedures and make sure they are appropriate with the LCD guidelines. You should be able to pull up the allowable dx codes from Trailblazer since they are the local carrier for Medicare there.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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.