Medical Necessity

Patient fractured humerus 10 days prior and is sent back to ER for a CT scan because of arm "turning blue". Report states "minimal pain" The CT scan is negative. Final diagnosis is hematoma, arm.Medicare is denying claim because no diagnoses meet Medical Necessity. Billing is trying to get us to code pain, which would, but as coders we feel that pain is integral to the hematoma and cannot be added.

I am curious as to how others would handle this.

What are you billing?

It would help to know if you are billing the CT scan or a physician E&M for the ER visit (or something else).

Medical necessity

Did you try ICD-9-CM code 782.5 (cyanosis). As this was the reason the physician ordered the CT and symptoms can be used.