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Diagnosis Code for IVIG coverage


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I am really confused. United Healthcare has rejected the initial claim for ds19's IVIG treatment. They have a letter online that says they cover IVIG for PANDAS without precertification. But his dr's office says that there is no diagnosis code for PANDAS (which is the diagnosis given my ds even without a known strep infxn since ~6yrs old) so they had submitted under the code for encephalopathy. Apparently that is the reason for the rejection of coverage as UHC says IVIG is not shown to be helpful for that.

 

So the dr's office is asking me to find out what they need to submit that under (so that it doesn't look to insurance like they are just trying any diagnosis code to get it thru) but when I call UHC, the lady says that they don't give diagnosis codes to dr's offices - the office is supposed to have that info not them.

 

Can anyone here tell me what diagnosis code worked for their insurance - ESP if you have United Healthcare?

 

Thanks!

~Grace

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Thanks, TexasDad! I found an old thread that was really helpful

http://www.latitudes.org/forums/index.php?showtopic=9678 & I'm going to add it here in case anyone else needs it.

 

Possible codes

 

323.8 encephalitis

323.9 unspecified cause of encephalitis, myelitis, encephalomyelitis

323.41 encephalitis and encephalomyelitis due to infection

348.30 encephalopathy unspecified

392 rheumatic chorea

392.9 rhuematic chorea without mention of heart involvement

333.0 other exptrapyramidal disease and abnormal movement disorders/ includes: other forms of extrapyramidal basal ganglia, or striatopallidal disease

279.3 unspecified immunity deficiency

279.4 autoimmune disease not otherwise specified

279.9 unspecified disorder of immune mechanism

 

UHC denied coverage for 348.3. His office is re-trying it with 279.4 and the 2nd one was went thru with 279.0 (hypogammaglobulin or some such). I'll try to post back which one - if either - worked.

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