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37799 and corresponding denied for medical necessity

Charles Posted Tue 24th of January, 2017 15:21:13 PM
I have been using 37799 with ICD-10 I83.811 since ICD-10 started and recently getting hit hard with denials for medical necessity. These are expensive procedures and the majority of the claims for the practice. Payments are terrible because I can't get Medicare and some other payers to pay even with an appeal with all possible documentation to accompany the claims appeal. I also can't figure out which category this would fall under. I need serious help to submit the appropriate information for payment. Can someone help?
SuperCoder Answered Wed 25th of January, 2017 07:58:09 AM

Varicose veins are caused by venous insufficiency as a result of valve reflux (incompetence). The venous insufficiency results in dilated, tortuous, superficial vessels that protrude from the skin of the lower extremities. Spider veins are dilated capillary veins that are most often treated for cosmetic purposes. Cosmetic treatment are not covered by Medicare.

If CPT code 37799 has been used to indicate such a procedure, then it would be considered as a cosmetic procedure.

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