APPEALS: Another denial we see is “This service has been provided at a frequency that is more than the medically appropriate indication by policy or regulation.” How can we avoid these denials?
Review the CPT/HCPCS codes billed and see if there is a NCD, LCD or MUE that has been established for the procedure code(s). If there is a policy in place review if the procedure meets an exception. If a medical appropriate exception exists, bill the service with an appropriate modifier and/or documentation to support the service. Review the CPT/HCPCS code descriptions to make sure its definition allows for how you are attempting to bill. Some questions to consider: Can the procedure be done multiple times? Is the code definition appropriate for multiple body areas/procedures?