decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 11 (November)
Improve your billing of 4 highly denied codes that might surprise you
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Article Overview
This article is for billers, coders, and clinical practices that want to understand why several high-volume services are often denied under Medicare. It focuses on broad coverage and documentation themes, including medical necessity, supporting diagnosis information, test frequency, chart documentation, and local policy references from CMS and Medicare administrative contractors.
Why This Topic Matters
These services are common enough that small documentation or coverage errors can create substantial denied charges and lost revenue. The article helps readers recognize which general compliance areas to review before submitting claims.
Article Sections
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Denial trends for common services
Introduces the services discussed and summarizes the denial patterns reported in Medicare claims data. It frames the article around primary care and specialty billing impact.
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Electrocardiogram billing considerations
Covers coverage and documentation themes related to electrocardiogram billing. The section focuses on general medical necessity and supporting record requirements.
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A1C testing frequency and coverage guidance
Discusses broad Medicare guidance for hemoglobin A1C testing and how frequency policies can affect payment. It references national coverage policy sources.
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Urinalysis documentation and local coverage
Reviews urinalysis billing issues related to result documentation and the need for a supporting reason for testing. It points to local Medicare coverage guidance.
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Vitamin B-12 injection coverage policies
Summarizes the policy themes surrounding vitamin B-12 injection coverage and the role of local Medicare contractor policies. The section addresses documentation and medical necessity considerations.
What You Will Learn
- Which general factors can contribute to denials for frequently billed services
- How Medicare coverage policy sources relate to common outpatient testing and injection services
- Why documentation and supporting chart notes matter for payment
- How local coverage policies can affect recurring service billing
Who Should Read This
- Medical coders
- Billers
- Revenue cycle staff
- Primary care practices
- Specialty practices
Codes Discussed
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