← Return to Medicare non coverage due to incorrect diagnostic code on claim

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Hi @caretakermom, I did not have 24 hour ambulatory BP monitoring at my 4 or 12 mo. visits. My BP is usually good. I live out of state, too, in IA and tx in MN. I had a pre-emptive living donor tx, and didn’t do dialysis thankfully. Billing errors can happen for anyone, but usually for me now and over the years at local providers I can get them resolved.
@gingerw It is great that your phlebotomist is so aware and caught those wrong codes!
My main local lab is where they told me Medicare never pays for Vit D etc. tests and wanted me to sign a waiver saying I would pay full price! I didn’t because they had a contractual relationship with BCBS and are required to accept what they determine my co-pay or co-insurance to be unless it is a non covered charge. I also plan to work past 65 if I am able, as I prefer to be able to keep my private insurance and it will increase my future pension. I took Medicare A & B as I was told if I didn’t they wouldn’t cover the tx meds after I turn 65 under part B. I still pay my BCBS premiums, deductible & co-pays/co-ins, too. Cost of living in IA is much less than CA, and my income is most likely way less and that is why I pay the basic $170.10 per mo. Medicare premium for part B. For me, it is expensive on top of everything else being single. I am thankful to work for the State and to have good benefits. I hope you can get your coding issue solved!

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Replies to "Hi @caretakermom, I did not have 24 hour ambulatory BP monitoring at my 4 or 12..."

Hi @jennifer0726, the ambulatory 24 hr bp monitoring test is a standard test Mayo Az orders for all patients in their 4 month post kidney txplant follow up which includes a biopsy. As I understand it, the 1 and 2 year follow up are similar to the 4 month follow up. So you are probably lucky your Mayo team didn't order one for you. All of the coding issues/Medicare non coverages we have incurred thus far(this is hubby's 2nd year on Medicare) are with the Mayo Az campus and they stem from labs that were ordered by the Mayo Az providers and done at Mayo Az. We were not told ahead of time whether a test is optional so when we show up for labs, we just assume it's medically necessary. By virtue of the Mayo provider ordering these labs, you would think the they are medically necessary!! You are right in that coding errors wrt to Medicare occurs often and it is not unusual for providers to make corrections. But for some reason it's is extremely difficult to make code corrections with Mayo Az, even when you have the provider's support to make the coding change!!! Thanks for your input!

Hi @jennifer0726, hope it's OK to PM you. Please check inbox!