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Posted By Lynn Radecky on 12-02-2020, 10:16:32 in Ob-Gyn
I have a patient that has Lynch Syndrome and it is recommended that she have an emb, CA125 and ultrasound annually. Her insurance company is denying the emb with dx code Z15.09 stating its not valid.... Is there a different code I can use? Thank You!
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Posted By Melanie Witt on 12-04-2020, 14:16:59
I think the problem is the tests you are ordering for this diagnosis. As you are performing tests for the presence of gyn cancers you should probably be using Z15.04 for the EMB, not Z15.09. I also would have reported Z15.02 for the CA125. In this case you should resubmit the claim, but also have your physician write a letter of appeal to the insurance company explaining the necessity of testing with this syndrome.
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