Corporate

January 5, 2015

Urinary Stent Placement (CPT Code 52332): Probe Medical Review, Ohio - Advance to Targeted Medical Review

The J15 Part A Medical Review department performed a service-specific prove review on claims for Urinary Stent Placement (CPT code 52332) in Ohio.  Based on the results summarized below, the probe edit review will be advanced to targeted medical review in Ohio.

Ohio Service-Specific Probe Edit Results:  Urinary Stent Placement  

 

Charges

Claims

Reviewed

$497,445.97

99

Denied

$436,805.05

85

Charge Denial Rate

87.8%

 

The top denial reasons associated with this review are:

5D164/5H164 –No documentation of medical necessity

Reason for denial:

  • This claim was fully or partially denied because the documentation submitted for review does not support the medical necessity of some of the services billed.

How to avoid denials:

  • Submit documentation to support all required components of the service when responding to the Additional Documentation Request (ADR).
  • A legible signature is required on all documentation necessary to support orders and medical necessity.
  • Use the most appropriate ICD-9-CM codes to identify the beneficiary’s medical diagnosis.

For more information, refer to:

If you receive an ADR from CGS, submit the requested medical record information within 30 days.  Before you send the requested records, we suggest you double-check the accuracy of your submitted claims. 

Completed review results will be posted on the CGS website.  Individual providers with significant denials will be contacted for one-on-one education.

If you have questions regarding this review, please call the CGS Part A Provider Contact Center at 866.590.6703.


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