Lore
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My brother Kevin (Cubbie) has Moyamoya
Posts: 819
Delaware, USA, usa, 419, 133, OH, Ohio
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Hi Greg,
The angio, in your case, is medically necessary....period. Docs don't do angios for the heck of it. There has to be a reason and the reason is...... you have this thing called an occluded artery, you are at risk for a stroke and you may very well have moyamoya. There is no question, in your case, the angio is medically necessary.
I have seen angios denied because the incorrect diagnosis or CPT code was used but that is an easy fix. The claim simply has to be re-filed using the correct codes. I have seen only one angio denied because of medical necessity and that decision was overturned on appeal. So you see, it is rare for an angio to be denied.
Sometimes, the only reason there is outpatient certification is to "track" certain procedures or to avoid unecessary procedures based on evidence based medicine. An angio is not, in your case, medically unnecessary. I seriously doubt you will have any problems with the insurance covering your medically necessary angio. If by some slim chance you do, there is an appeal process in place and without question your doc can support the medical necessity. In your case, I would not be concerned with the medical necessity of you having an angio.
Glad to hear you got a ride to and from the hospital and I'm glad to hear Olga is going to be with you.
I know the waiting is the toughest and sometimes feels like it is forever but know that by having the angio you will have better knowledge of your particular situation and hopefully a firm diagnosis.
You and Olga will be in my thoughts.
Keep us posted and let us know the outcome.
Hugs,
Lore
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