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Appealing a denial for 43270

Susan Posted Mon 12th of August, 2019 12:06:18 PM
This patient has Barretts Esophagitis k22.70 and had an EGD with Ablation 43270. BCBS of Georgia has denied due to "not covered" when deemed experimental/unproven. What documentation can I use for an appeal to fight the denial?
SuperCoder Answered Tue 13th of August, 2019 10:14:55 AM
Hi Thanks for your question Firstly the documentation should be thoroughly reviewed and whether the code is applicable to the medical documentation and medical necessity is established for the procedure Secondly the denial states not covered when deemed experimental unproven this may suggest that there is insufficient or inconclusive medical...

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