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code 28289

Frances Posted Fri 26th of March, 2010 13:18:59 PM

We are in Pa using FI Highmark Medicare Service and received a denial on this code as being deemed not medically necessary therefore non covered. The code is listed on the approved procedures in a ASC setting. Has anyone found his problem. The denial refers to 835 healthcare policy I which states effective as of 7/1/2010 Any help will be appreciated

SuperCoder Answered Fri 26th of March, 2010 13:53:49 PM

This denial refers to 835 healthcare policy , but this policy narrates several reasons for denials, so please do check further for Claim Adjustment Reason Code (CARC).
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6742.pdf
Also do check if you are billing with a compatible ICD (735.2), a correct modifier and checking the bundling issue. If not do send me the Op report.

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