Thursday, December 15, 2011

Denial - Routine exam or screening procedure done in conjunction with a routine exam

PR 49 - These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam


Resources/tips for avoiding this denial

Denial indicates the procedure code and/or evaluation and management (E/M) service was billed with a screening diagnosis.

• Note: Medicare does not cover diagnostic/screening procedures or E/M services for routine or screening purposes, such as an annual physical. This denial would be appropriate in this case.

• Before submitting a claim, you may access the Procedure to Diagnosis Lookup/Service Indication Report to determine if the procedure code to be billed is payable under the specific diagnosis.

• Refer to the “Active/Future/Retired LCDs” medical coverage policies for a list of procedure codes, relating to services addressed in the local coverage determination (LCD), and the diagnoses for which a service is/is not considered medically reasonable and necessary.

Tips to correct the denied claim

• If a payable diagnosis is indicated in the patient's encounter/service notes or record, correct the diagnosis and resubmit the claim.

• Do not resubmit an entire claim when a partial payment has been made; correct and resubmit denied lines only.

No comments:

Post a Comment

Popular Posts