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Breathing Treatments -- Denied -- help

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BREWERBILLING:
Oh and I have contacted Medicare asking why the denial -- their standard response is "we can't tell you how to bill you have to figure it out".  They won't even refer me to anyone that can answer the question.

Michele:
You should specifically ask them if they can point you to information on the LCD or NCD on breathing tx or 94640.  You aren't asking them to teach you how to bill.  Anyway, I found the following on the LCD's:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=14749&ContrTypeId=1&ver=17&ContrNum=00520&SearchType=Advanced&CoverageSelection=Both&NCSelection=NCA|CAL|NCD|MEDCAC|TA|MCD&ArticleType=Ed|Key|SAD|FAQ&PolicyType=Final&s=All&CntrctrType=1&KeyWord=94640&KeyWordLookUp=Doc&KeyWordSearchType=Exact&kq=true&bc=IAAAACAAAAAA&

It looks like the only dx you have that would be medically necessary for the treatment is the 786.2.  I'm not sure how you have it coded, but I can't tell you how to code it either.  (I'm not a certified coder and I don't have the notes/chart.)  The provider should be sending it over to you coded, unless you are the coder.  But if you look at the web page above it does indicate what dx's it is covered for and which ones it isn't.

Good luck!

Michele

PMRNC:

--- Quote ---Oh and I have contacted Medicare asking why the denial -- their standard response is "we can't tell you how to bill you have to figure it out".  They won't even refer me to anyone that can answer the question.
--- End quote ---

That's correct, insurance carriers are NOT allowed to tell you how to code or bill charges. They are not even supposed to tell you the amount needed to reach the deductible.

BREWERBILLING:
Judging from the link you gave me -- I am billing correctly, insurance is just not paying when there are multiple services rendered that day. Thanks for the help, but it looks like this is a freebie for our patients.

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