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Medicare Denied

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mruiz12:
I Just received a denial from medicare for cpt 77081 appendicular skeleton with dx of 733.90 disorder of bone and cartilage unspecified. Does any one know if their is supposed to be a new cpt and dx for this. This is the first denial that i have received I called medicare they told me to look on the cms website. This takes along time just to find things on their website. Please advise.

Michele:
I would need more info.  What specifically was it denied for?  What state are you in?  My local Medicare carrier's website indicates that 77081 would be covered for 733.90.

Michele

deloga:
Hi,

In my state the dx does not cover the procedure 77081, I was running into the problem of some dx's not matching the cpt, after printing out the segment for my Physicians they provided me with new primary codes.

Pay_My_Claims:
Per Medicare Website..........and as far as i know this would apply no matter where you reside since Medicare is a Federally funded program. I think the only difference location plays is the fee schedule (please correct if I am mistaken)

#  Contractors will pay claims for monitoring tests when coded as follows:

    * Contains CPT procedure code 77080, and
    * Contains 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 as the ICD-9-CM diagnosis code.

# Contractors will deny claims for monitoring tests when coded as follows:

    * Contains CPT procedure code 77078, 77079, 77081, 77083, 76977 or G0130, and
    * Contains 733.00, 733.01, 733.02, 733.03, 733.09, 733.90, or 255.0 as the ICD-9-CM diagnosis code, but does not contain a valid ICD-9-CM diagnosis code from the local lists of valid ICD-9-CM diagnosis codes maintained by the Medicare contractor for the benefit’s screening categories indicating the reason for the test is postmenopausal female, vertebral fracture, hyperparathyroidism, or steroid therapy.

Michele:
You're right!  Doesn't matter what state.  :)

Michele

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