You are a Coding Denial Specialist at ABC Medical Hospital. One of…

Question Answered step-by-step You are a Coding Denial Specialist at ABC Medical Hospital. One of… You are a Coding Denial Specialist at ABC Medical Hospital. One of your roles is investigating denials as they relate to the claim submissions. Read the patient scenario and carefully review the insurance denial information, along with the ICD-CM, CPT, and/or HCPCS Level II procedure codes that were submitted to the insurance company. Then provide correction(s) to be re-submitted to the insurance company and provide a detailed rationale as to why the insurance claim was denied. Patient  Scenario Insurance Denial Reason: Invalid CPT Authorization- the CPT pre-authorized was not final coded  ICD-CM Billed: M54.5 Low back painCPT Procedure(s) Billed: 64490, Injection of therapeutic agent, paravertebral facet joint with imaging guidance at cervical or thoracic regionHCPCS Level II:  J3301 X 4 Kenalog 40mgA 32-year-old patient was experiencing low back pain.  The scheduling coordinator called the insurance company as a prior authorization was required.   A CPT code was requested by the insurance company to ensure it was covered and the surgery was scheduled. The physician took the patient to the operation room and injected a steroid in the Lumbar 1 facet joint.  Science Health Science MEDICAL REIMBURSEMENT AND CODING MCCG262 Share QuestionEmailCopy link Comments (0)