Results 1 to 7 of 7

Echo Denials

  1. Default Echo Denials
    Medical Coding Books
    I recently received a list of denials (thankfully very, very short) and was asked to determine the reasoning. In the echo report, there were no findings--everything was normal. The "reason for test" is "evaluation of left ventricle function" or r/o "pericardial effusion", etc. The ICD-9 code used was V81.2 and this is being denied every time for inpatient visits.

    Also some reports only say VSD s/p repair so V15.1 is being coded along with V81.2.

    Does anyone have any suggestions on what code to use? Referral diagnosis is listed, but sometimes one is given such as leukemia and that isnt a payable dx for an echo.



  2. #2
    are there any signs and/or symptoms that can be coded? i.e. chest pain, a fib... there has to be some reason why they are evaluating ventricular function... and wanting to rule out an effusion

  3. Default
    no signs/symptoms to help out....

    some pts have "baseline echo prior to chemo", "rhabdomyosarcoma vs leukemia; elvaluate for mass", and some with "VSD s/p repair" as referral diagnoses. Then the reason for the test states assess cardiac function, etc.

  4. #4
    Hartford, CT
    Are these medicare claims, and if so do you happen to have NGS as your medicare carrier? If so, we are having the same problem. According to LCD #L28169, V81.2 is a valid ICD code for the echo, but they are getting denied anyway. We've been tracking the denials and appealing them, no response yet to our appeals.

    Doreen, CPC

  5. Default
    no, they're commercial

  6. #6
    Hartford, CT
    Some commercial insurance only allow certain ICD codes with echos. They (especially Aetna) will not pay because they consider the use of echos for any reason other than their established codes to be experimental. You can get the policies from most insurance co. websites and the policy will list ICD codes that are usable.

    Doreen, CPC

  7. Default
    It sounds as though you're going to have to appeal w/ notes for those denied claims. That's what I've been doing and the insurances have been paying. The one I do have difficulty with is Aetna. Aetna was paying my appeals but for the last month or so, they haven't.

Similar Threads

  1. Replies: 5
    Last Post: 02-19-2013, 03:12 PM
  2. Baseline echo before dobutamine stress echo
    By mshelly87 in forum Cardiology
    Replies: 0
    Last Post: 06-22-2010, 08:11 AM
  3. 2009 Echo, Stress Echo, Limited Echo Codes
    By laurap in forum Cardiology
    Replies: 8
    Last Post: 07-01-2009, 10:25 AM
  4. Limited echo prior to stress echo
    By mfanning in forum Cardiology
    Replies: 1
    Last Post: 05-22-2009, 01:30 PM
  5. ProFee Billing for Echo and EKG denials
    By jrumble in forum Medicare Regulations
    Replies: 1
    Last Post: 04-23-2009, 05:46 PM

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?


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.