Medicare non coverage due to incorrect diagnostic code on claim
My husband is about 6 months post kidney transplant which he received from Mayo Clinic Az. He has Medicare as his primary and employment insurance as secondary. Thus far, there are 3 lab tests that Medicare denied coverage and for which he did sign ABNs. Medicare denied coverage because the code submitted on the claims did not indicate medical necessity(even though these tests were standard tests ordered for post transplant patients). Upon closer scrutiny, I discovered that the labs were originally ordered with the wrong codes, codes that are too general to convey specific medical conditions. Unfortunately, our nurse coordinator says these tests were ordered months ago, and neither she nor her staff ordered them. Apparently, the order was put into the system by another department and these are all standard orders for post kidney transplant patients.
I'm having a devil of a time getting Mayo to correct these codes, no one seems to know what is the proper procedure and which department is responsible to make the change. I have called billing many times and they say they cannot make any changes. They directed me to the Records and Amendment Dept and the lady there says she's not the one to make the change either. The nurse tried to do it via the patient chart on Epic but the changes she put in got reversed overnight by the software. So Epic is not updating it either for whatever reason(probably due to IT issues). I have spoken with the provider office(nurse coordinator) she gave me the corrected ICD-10 codes to use for the non covered claims but I'm unable to find anyone at Mayo who can help me resolve this issue. Just FYI, billing is inert because they go by what is on the original order. Does anyone have any idea who I can call for help? Is there a patient advocacy program I can talk to? I just don't understand why they can't make changes to the codes, even though we have support from the provider office. Error in coding happens often and there should be a way to resolve!! Suggestions/advice welcome. Looking forward to hearing from you!!