73564 denial

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hi I am new to orthopedic and I keep getting a denial for 73564 RT with diagnosis S80.01XA indicating diagnosis inconsistent with procedure, any advice would help,

thank you

Laura
 

mitchellde

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Was this the initial encounter to evaluate an injury? If no further injury is evident perhaps a Z04 code for evaluation following accident with nothing found. Or perhaps you need to add the external cause codes.
 
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denial 73564

Hello

I work in the orthopedics department at UT medical center and I bill for this knee xray all the time. The Dx used is for a contusion right knee which ICD 10 (s80.01xa) cross maps to icd-9 (924.11). Per the Encoder the Icd 9 code(924.11) was consistent with 73564 in 2009 Since the ICD 10 change a lot of insurances are not recognizing the 10 codes as necessary for injections, xrays and etc. Here in my office we make the insurance company mapp the ICD 10-DX back to the ICD -9DX code that was paid before October and have them rebill the claim and if notes are needed send notes. I get many denials for 10 codes because the insurance companies are lazy and will deny your claim for any reason. If you have coding software you need to enter your DX to see the CPT codes that will get paid to have proof when appealing the insurance decision.

Hope that helps
 
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73561

thank you letitiadickerson@yahoo.com yes our software does have it but i will call the billing call ins. company and let thme know that and yes if they want notes i will send it, i couldnt understand why it wouldnt pay, but like i said im new to orthopedic billing it really helped, i take any advice and appreciate it
 
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