03/12/2018

BCBS Denials-Evaluation Code With Diagnosis Codes G57.61/62

We keep getting denials from BCBS when we bill an evaluation code with diagnosis codes G57.61/62. The denial codes are C011 and N657. Any idea what's going on with this? Thank you

E&M codes are being denied because the insurance does not deem the diagnosis medically necessary for an office visit. The diagnosis being used states lesion and would require more description and/or detail i.e. Is the lesion suspicious? Is the lesion painful? Did the lesion’s shape change? When coding for an E& M, a chief complaint should be listed as the primary diagnosis.