Cathy Posted Thu 22nd of October, 2015 16:35:36 PM
I am in Texas and I am having problem with Texas Medicaid not paying for our routine ultrasound screening 76801 and 76805. In icd 9 we used V28.3 I went to an ACOG coding class. We were told to use Z36 Our claims are being denied and of course they are not telling us what code we should use. Can you help?
SuperCoder Answered Fri 23rd of October, 2015 00:26:49 AM
CMS published ICD-10 CM code Z36 as GEM map code for V28.3. So, you are using the correct code.
Kindly touch base with your insurance to confirm the reason (not code, as they won't disclose the code), why they are denying the case.
Cathy Posted Tue 27th of October, 2015 00:00:31 AM
Can you give me the link on CMS that shows the conversion on V28.3 converting to Z36. When I contacted Texas Medicaid the representative told me that he could not find any reason why this did not pay, and had me resend the claim through again through telephone appeal and again this week is was along with other ultrasounds it was denied. All other CMO are paying and they are suppose to follow Traditional Medicaid guidelines so I cannot understand what the problem is.
SuperCoder Answered Tue 27th of October, 2015 01:17:24 AM
You can check the cross mapping code for V28.3 as Z36 on CMS website. Please find below the link. https://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html Check for 2015 General Equivalence Mappings (GEMs) data.