Postpayment Service-Specific Probe Results for Echocardiography, Transthoracic, Real-time with Image Documentation for July through September 2021


Palmetto GBA performed service-specific postpayment probe review on Echocardiography 93306 — Echocardiography, transthoracic, real-time with image documentation. This edit was set in Alabama, Georgia and Tennessee. The results for the postpay review, for claims processed July through September, 2021, are presented here. 

Cumulative Results 
A total of 36 claims were reviewed in Georgia and Tennessee, with no claims reviewed in Alabama, for the July through September processing period. Of the claims reviewed, three of the claims were either completely or partially denied, resulting in an overall claim denial rate of 8.33 percent. The total dollars reviewed was $2,601.80, of which $216.66 was denied, resulting in a charge denial rate of 8.33 percent. Overall, there were 184 auto-denied claims in the region. The top denial reason was identified, and the number of occurrences based on dollars denied are:

Percent of Total Denials

Denial Code

Denial Description

Number of Occurrences

100.00%

NOTML

Per Applicable LCD, Payer Deems the Information Submitted Does Not Support the Medical Necessity of the Services Billed

3

Alabama Results
No results for Alabama have been processed for the July through September, 2021, quarter.

Georgia Results
A total of two claims were reviewed in Georgia. Neither of the claims were either completely or partially denied, resulting in a claim denial rate of 0.0 percent. The total dollars reviewed was $146.32, of which $0.00 was denied, resulting in a charge denial rate of 0.0 percent.

Tennessee Results
A total of 34 claims were reviewed in Tennessee, with three of the claims either completely or partially denied. This resulted in a claim denial rate of 8.82 percent. The total dollars reviewed was $2,455.48, of which $216.66 was denied, resulting in a charge denial rate of 8.82 percent. The top denial reason was identified, and the number of occurrences based on dollars denied are:

Percent of Total Denials

Denial Code

Denial Description

Number of Occurrences

100.00%

NOTML

Per Applicable LCD, Payer Deems the Information Submitted Does Not Support the Medical Necessity of the Services Billed

3

Denial Reasons and Prevention Recommendations

NOTML — Per Applicable LCD, Payer Deems the Information Submitted Does Not Support the Medical Necessity of the Services Billed

  • Ensure that all documentation to support medical necessity of the service billed is submitted for review. This includes original chart notes and any diagnostic, radiological or laboratory results.
  • Verify that documentation to support the level of service billed is included. Verify that documentation to support the level of service billed is included. Please refer to the LCDs and NCDs page on Palmetto GBA's website.
     

NODOC — Documentation Requested for this Date of Service Was Not Received or Was Incomplete; Therefore We Are Unable to Make a Reasonable and Necessary Determination (as Defined Under Section 1862(A) (1) (A) of the Act for the Service Billed and This Service Has Been Denied)

  • Submit all documentation related to the services billed within 45 days of the date on the ADR letter
  • Review documentation prior to submission to ensure that the documentation is complete and that all dates of service requested are included
  • Include any additional information pertinent to the date of service requested to support the services billed. For example: original chart notes, diagnostic, radiological or laboratory results.
  • For claims denied with a M127 or N29 code listed on the remittance advice, be sure to submit all documentation for all dates of service on that claim with a reopen/redetermination request form by fax to JM Part B (803) 699–2427, JJ Part B (803) 870–0139, or RRB Appeals (803) 462–2218
     

The Next Steps
The service-specific postpayment medical review edits for Echocardiography 93306 — Echocardiography, transthoracic, real-time with image documentation in Alabama, Georgia and Tennessee have been discontinued based on the resumption of the Targeted Probe and Educate (TPE).

If you are dissatisfied with a claim determination you have the right to request an appeal. Palmetto GBA encourages you to review the documentation originally submitted, and if you believe you have additional supporting documentation you may include this information with your appeal. For more information related to the appeals process please refer to the JJ Redetermination: 1st Level Appeal form (PDF, 232 KB). Questions regarding this medical review can be directed to the Palmetto GBA Provider Contact Center at 877–567–7271.





Last Updated: 11/08/2021