IP LOC and DRG/Coding Clinical Validation on the same encounter

christy.basden@iredellhealth.orgchristy.basden@iredellhealth.org
in DENIALS & APPEALS

Hi all!

I have an encounter that originally denied for med nec of IP LOC, I appealed and the denial was overturned, claim paid. 90 days later (give or take a few days), I received a DRG/Coding Clinical Validation denial on the exact same encounter. Is this legit? I have been told that this type of practice is not valid, but I cannot find anything in writing that I can use as support. I have searched the CMS IOM and the MA payer site and have come up empty handed. Any advice would be greatly appreciated.

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