Start with one remittance file.
We'll identify what's appealable, draft the letters, and return them within five business days. You'll have a clear answer on whether this is worth continuing.
contact@robinrcm.comMost denied imaging claims are winnable. They get written off because building the argument takes time nobody has. We build it — and we show our work.
NCD 220.2 establishes that MRI is useful in examining the head, central nervous system, and spine, and that its tissue contrast resolution makes it an appropriate standard diagnostic modality for general neuroradiology.1 Coverage requires that the service be reasonable and necessary for the diagnosis or treatment of the specific patient. CPT 70553 is, by definition, an MRI examination of the brain — squarely a head and central nervous system examination as described in the policy.
The patient presented with new-onset generalized seizure with post-ictal confusion and no prior history of seizure disorder. A prior non-contrast CT showed no acute hemorrhage but was non-diagnostic for mass lesion or vascular malformation, so a structural intracranial cause had not been excluded by prior imaging.2 Contrast-enhanced brain MRI was ordered to evaluate for a structural epileptogenic focus, vascular malformation, or demyelinating disease.
R56.9 documents the new-onset seizure with post-ictal confusion. R51.9 and H53.2 document associated neurologic findings on follow-up examination.3
This study is contrast-enhanced imaging of the brain parenchyma — not MRI of cortical bone or calcifications, and no metallic aneurysm clips are documented. Those are the only nationally non-covered indications under NCD 220.2 relevant here.4
Quoted from the NCD itself. Not paraphrased and not recalled from memory — pulled from a coverage library where every entry was read against the source document and verified by a human, and dated.
Only documented facts. Every clinical statement traces to the record. Nothing is inferred to strengthen the argument.
Codes tied to covered uses. Each diagnosis is mapped to the specific indication it supports, not listed for volume.
The exclusions are checked too. A reviewer looking for a reason to uphold the denial finds it already addressed.
The letter above is only as good as what it cites. So the work isn't the writing — it's the sourcing behind it, built one procedure code at a time.
MRI of the brain, cervical, thoracic and lumbar spine, and upper and lower extremity joints. CT of the head, chest, abdomen and pelvis, and full spine.
NCD 220.2 for MRI and NCD 220.1 for CT — national coverage determinations that bind traditional Medicare and, by federal rule, Medicare Advantage plans.
No placeholder policy, no coverage language written from memory. Every entry carries the source document, its version, and the date a human verified it.
When a denial falls outside the sourced library, or the record doesn't contain a specific documented indication, the system routes it for review instead of writing an argument it can't support. A weak appeal is worse than none — it burns the claim.
Every identifier is stripped and replaced before anything is transmitted, and an automated check blocks the request outright if one is detected. Names and numbers are reinserted locally, after the draft comes back.
Your biller forwards the 835 remittance they already receive. About thirty seconds.
We separate the winnable denials from the ones not worth appealing, and tell you which is which.
Finished, ready-to-submit letters back to you within five business days.
Your team reviews and files under your own credentials. We track outcomes and bill only on recoveries.
We'll identify what's appealable, draft the letters, and return them within five business days. You'll have a clear answer on whether this is worth continuing.
contact@robinrcm.com