Ken15
Active member
- Joined
- Jan 9, 2018
- Messages
- 76
- Reason
- Lost a loved one
- Diagnosis
- 09/2017
- Country
- US
- State
- SC
- City
- Hilton Head Island
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
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