tci ED Coding & Reimbursement Alert - 2018 Issue 4

Reader Question: Check Payer Policies Before Filing Appeals

Question: We performed imaging for a patient who had a complaint of abdominal pain, and we received a denial for medical necessity from the insurance company since it turned out that nothing was wrong with the patient after all. Should we appeal? Supercoder.com Subscriber Answer: The answer depends on the payer policy for the particular imaging service you performed. If you check the coverage determination and discover that abdominal pain is not a covered diagnosis for that test, you may need to think further about whether the appeal is worth your time. When considering whether another diagnosis is...

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