Liz Posted Tue 03rd of November, 2015 11:46:36 AM
I was using 413.9 Angina with ICD9 and it seems the Medicare policy changed Oct 1. Now all the claims are being denied for diagnosis using I20.9 Is there a more specific code needed? I can not find a Medicare policy.
SuperCoder Answered Wed 04th of November, 2015 04:43:33 AM
We found, there is no such change in the general policy. For HCPCS- G0166 (External counterpulsation), per treatment session, following are the ICDs covered:
ICD-9 Codes- 413.0, 413.9 & 414.00-414.07.
ICD-10 Codes- I20.8-I20.9, I25.10-I25.119, I25.700-I25.799 & I25.810-I25.812.
Documentation Requirements for the scenario- Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request. Whereas, eligibility for reimbursement is based upon the benefits set forth in the member’s subscriber contract.
Codes may not be covered under all circumstances. It is suggestible to check the guidelines statements of the patient insurance coverage & check for the reason of denial- fulfil it and re-submit the claim.