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Medicaid denied dx 584.6 for cpt 76937 as inappropriate

  1. Default
    Medical Coding Books
    There are a few problems here that I would get corrected before you do anything else. Nothing is documented and what is documented needs verification. A Shiley Cath is typically a non-tunneled placement (36556) However your physician indicates in his impression that it was a "long bone tunnel dialysis catheter" - That being said - it does appear to be a transcription error somewhere - you may want the clairification before you use the 36556. Next neither the 76937 or 77001 are documented according to AMA standards and coding for such can lead to problems if this reports happens to get audited and will open the practice up to additional audits. Everyone hates getting a physician to change his / her "ways" - but the doc needs to understand that CMS is coming down on things like this extremely hard.

    As far as the dx goes - there is nothing in the report that comes close to supporting the use of 584.6 - where did that come from? The report supports the use of V56.1 - since the encounter is not for renal failure but the dialysis cath placement. If you have documentation to support 584.6 that should be used as a secondary dx.
    In my experience V56.1 is a payable code by medicaid standards and should be used as primary in placements of dialysis caths.
    As far as the NJ Medicaid website it is www.njmmis.com
    Hope that helps some!
    Carrie

  2. #12
    Default
    Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

    Btw can you refer me any Interventional radiology coding guidelines in books or websites?

  3. #13
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    Quote Originally Posted by she803 View Post
    Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

    Btw can you refer me any Interventional radiology coding guidelines in books or websites?
    www.zhealthpublishing.com. Dr. David Zielske is one of the premier authorities on Interventional Radiology and he has written several books on the subject. He is a former member of the AAPC National Advisory Board.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. Default
    Quote Originally Posted by she803 View Post
    Thanks for the info. Truly appreciate it. I informed billing dept to delete the code. I dont do the initial coding--I receive denials from billing dept to correct and/or appeal denials based on the reports and some of these reports are so confusing and inaccurate that it's ridiculous sometimes! That's why i was wondering as to how to code this report in particular. Interventional Radiology is challenging enough as it is but when they submit codes based on reports that are incomplete and inaccurate they make it that much more difficult for us...

    Btw can you refer me any Interventional radiology coding guidelines in books or websites?
    Z health is a bible for IR coders. Another good resource is http://www.sirweb.org/ and the ACR publishes the Interventional Radiology Coding User's Guide which is another great tool!

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