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Wiki 43450 & Humana Medicare

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cayladenver@hotmail.com

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I'm looking for some insight on assigning an appropriate dx code to 43450 for esophageal dilation. Anytime that I use the dx of K22.2 for a stricture, it gets denied as "inconsistent diagnosis with procedure". This makes no sense to me...Maybe I'm completely missing something here. I have called them, discussed with code editing team, and get nowhere. I've tried filing with R13.10, K22.2. I've tried filing with the primary diagnosis of the endoscopy performed on same DOS with the stricture dx as secondary and it continues to deny. Does anyone have any experience with this? This is the only payer that I have this problem with. I appreciate any feedback!!

Thanks and have a great day!
 
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