Wiki Denial for procedure inappropriately coded

[patdow]

We received a denial from Community Health Choice for Procedure Inappropriately Coded. We billed a hospital consult with CPT code 99223. The ICD 10 codes are K74.60, K75.4, K83.01, K85.90, D89.9, and Z94.4. I’ve billed these codes before without an issue. The insurance rep confirmed that 99223 had not been billed by any other provider for that DOS but did state the coding was wrong for dx coding. Can someone please help me understand what I need to change?

 

[sls314]

We received a denial from Community Health Choice for Procedure Inappropriately Coded. We billed a hospital consult with CPT code 99223. The ICD 10 codes are K74.60, K75.4, K83.01, K85.90, D89.9, and Z94.4. I’ve billed these codes before without an issue. The insurance rep confirmed that 99223 had not been billed by any other provider for that DOS but did state the coding was wrong for dx coding. Can someone please help me understand what I need to change?

One thing that jumps off the top of my head is that you're coding Autoimmune Hepatitis (K75.4) along with D89.9 - Immune Disease NOS.

I wouldn't use the D89.9 - what's it supposed to represent? You have a specific autoimmune diagnosis on your claim.

Taking into consideration another thread you have about the same payer where D89.9 was used, I might speculate that the payer does not like this code.

Remember that just because they let it slip through before, doesn't mean that they will continue to do so in the future. Many payers have been fine-tuning their processing systems to more closely mirror coding conventions and guidelines.

(Do payers always implement diagnosis code edits perfectly? No. However, D89.9 is a code that I personally would only use very, very sparingly in circumstances where the documentation just doesn't support any more specific codes. It's super generic and doesn't do much to paint a picture of the patient's condition.)