ICD-9 Code Denials

[URCOD]

We have been getting denials from Medicare for the ICD-9 codes 600.01 (BPH w/obstruction) and 185 (prostate cancer) due to not being coded to highest level of specificity. Does anyone have any ideas on this?

[Kelly_Mayumi]

I haven't seen a denial like that, but 600.01 has a note to add the urinary symptom (788.XX). Would that help?

[mitchellde]

Your 185 is fine I am not sure what the problem could be there, you should appeal with a copy of the page out of the code book. Th 600.01 does require a secondary code for the symptom so that should fix it just fine. Is there any additional information you can supply?

[shaanah]

You may need to review any current LCDs if those dx are attached to procedures. If E&M you should not need any other dx. Sometimes Medicare has bad batch runs and a simple call to customer service will help get the claim to reprocess correctly.

[scronin]

Why would you report the code 600.01 for benign hypertrophy of the prostate and then apply the code 185 for prostate cancer? If a patient has prostate cancer with obstruction you should report the cancer and the urinary obstruction code 599.69.

[URCOD]

Originally Posted by scronin

Why would you report the code 600.01 for benign hypertrophy of the prostate and then apply the code 185 for prostate cancer? If a patient has prostate cancer with obstruction you should report the cancer and the urinary obstruction code 599.69.

These denials were on separate patients and claims. The two codes weren't used together.

[cynsim1217]

It depends on what you're trying to bill. If you are billing a residual ultrasound, for example, those diagnoses will not work.