Wiki Diagnosis being denied

[adamsc]

Medicaid is deny this for mismatched diagnosis can anyone share thoughts?

Billed:

M86.18 OTHER ACUTE OSTEOMYELITIS, OTHER SITE
S82.62XA DISP FX OF LATERAL MALLEOLUS OF LEFT FIBULA, INIT
S91.022A LACERATION WITH FOREIGN BODY, LEFT ANKLE, INITIAL ENCOUNTER

27603,78 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA, RETURN TO THE OR FOR A RELATED PROCEDURE DURING THE POST OP PERIOD

 

[Orthocoderpgu]

Your diagnosis for osteomyelitis is for "Other site", but there is another ICD.10 that matches this anatomical location.

Modifier -78 would not be used with a diagnosis that ends in "A".

 

[thomas7331]

You've also billed a procedure for the drainage of an abscess but have not coded an abscess diagnosis.

 

[dkissel]

Modifier -78 would not be used with a diagnosis that ends in "A".

Could you explain why the A diagnosis would not be used with modifier 78? It was my understanding to to use A during the active treatment for this diagnosis and to begin using D for routine healing and after care. If I have interpreted incorrectly, I'd like some input. Thank you!!!

 

[Orthocoderpgu]

Modifier -78 means that a surgery was performed prior to the surgery that the modifier is attached to. After that first surgery you would be in the "healing" phase as you call it so "D" would be used after that first surgery.

 

[dkissel]

Modifier -78 means that a surgery was performed prior to the surgery that the modifier is attached to. After that first surgery you would be in the "healing" phase as you call it so "D" would be used after that first surgery.

I do understand that -78 would be used on a complication returning to the OR, however, at that point would the healing be considered "routine" if it does cause a return to the OR?

 

[Orthocoderpgu]

This is a "continuation" procedure. This is not the main procedure. Patient's with osteomyelitis frequently return to the OR multiple times for continued treatment, but even though the patient is returning to the OR, it's still a continuation of treatment so it would be billed with "D".

Thanks Thomas my brain was on autopilot. Osteomyelitis does not change the letters. But the injury codes do. I can't believe I did that.

 

[thomas7331]

This is a "continuation" procedure. This is not the main procedure. Patient's with osteomyelitis frequently return to the OR multiple times for continued treatment, but even though the patient is returning to the OR, it's still a continuation of treatment so it would be billed with "D".

Osteomyelitis ICD-10 codes don't carry the seventh digit for initial/subsequent/sequela designations. I think your speaking of cases of multiple procedures for fracture care aren't you? If so, then yes the D may be appropriate for a procedure that is an additional course of treatment for that fracture. But the modifier 78 can also apply to a return trip to the OR that is for a new injury or condition, where an 'A' might be applicable, or complication, such as the abscess in the example above in which case the subsequent encounter fracture code might be a secondary diagnosis. I don't think we can say definitively that a modifier 78 never involves an 'A' initial encounter code - each record really has to be evaluated on its own content to make that determination.