Forum - Questions & Answers

Aug 30th, 2016 - mbrigham 1 

medical necessity

We had a 43235 (EGD) denied for medical necessity due to NCD edits. However we cannot find any NCD edits for this code. Any suggestions?
DX codes used were Anemia, Epigastric pain, and bariatric surgery status. Any help would be appreciated.

Aug 30th, 2016 - rphelps 615  1 

re: medical necessity

NO cci edits for 43235. I would have used the epigastric pain as primary. Don't think anema will get it paid.

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