5 Most Commonly Denied Procedures in Ambulatory Care

Here are the top five most commonly denied procedures and descriptions codes for ambulatory healthcare facilities.

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Data is based on 25 percent of all national outpatient remittances from May 7 to August 13 from RemitDATA, an independent source of comparative analytics for reimbursement, utilization and productivity data.

1. Procedure Z7610. Miscellaneous drugs and supplies for non-surgical procedures are billed with HCPCS code Z7610. This code may be used only by hospital outpatient departments, emergency rooms, surgical clinics and community clinics.

2. Procedure G0249. Diagnostic laboratory — provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting of test results to physician; per four tests.

3. Procedure 99213. Low complexity office or other outpatient visit for the evaluation and management of an established patient.

4. Procedure 36415. Diagnostic laboratory — collection of venous blood by venipuncture.

5. Procedure 97110. Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility.  

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