Medicare & Multidisciplinary Clinic

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Ken15

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My PALS has had her first 2 MDC's @ Mayo Clinic (FL) and Medicare has approved all associated claims except for her neurologist's charges.

Naturally, these are the most expensive charges ($305).

The procedure codes submitted by the Mayo are 99215 and 99354, with a diagnosis code of Z82.0.

In denying these line item charges, Medicare says they don't pay for "routine examinations". I called the Mayo Clinic and they said these codings are what they normally submit to Medicare for multidisciplinary clinical visits.

I filed a first level appeal with Medicare, which was denied for the same reason.

Upon further investigation, the Z82.0 diagnosis code is for "Family history of epilepsy and other diseases of the nervous system" (none of these other diseases are ALS).

A further search reveals that ALS has it's own diagnosis code of G12.21. Not sure why the Mayo submits under Z82.0 and not G12.21.

I would appreciate any input or guidance from those who have successfully multidisciplinary clinic claims with Medicare.

TIA,
Ken
 

Nikki J

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That code can be used of family history of ALS but you won’t get medicare to pay. Mayo needs to recode. With whom did you speak at Mayo?

I had a different issue but similar last year when my neuro visit was coded for an uncovered service. What happened was the new computer system had assigned an incorrect code. My neuro put in a covered diagnosis in words but the numbers, unbeknownst to her said something completely different and the claim was rejected. The neuro had to recode and the billing people had to resubmit Once that happened it was paid.

I dealt with this through the neuro’s office.
 

Ken15

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Lost a loved one
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Thanks, for your reply.

Initially, I spoke to someone in Mayo billing, but when it seemed they didn't know, I called the Neurology Dept. They said it their typical coding.

I will call back. Do you recall what code was successfully used? Was the G12.21?
 

Nikki J

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I don’t know what code mine was changed to. That code should work though. Tell them the Z code won’t be paid for as the primary diagnosis so they need to put something else so it gets paid for and since she has an ALs diagnosis couldn’t they pleae use this? It is odd that they need to be told. In my case it was a new computer system and when they saw what had happened my clinic immediately agreed fixed my issue and presumably had their IT fix the link
 
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