isapra
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We are getting Cigna Denial for LARC and DPMA stating that Z30.430,z30.017, z03.013, z30.42 can't principal diagnosis. Anyone has suggestion as to what diagnosis should be used as principal diagnosis in this case?
If a patient is being actively being treated for a condition, it's not appropriate to assign a history code. Sadly, many providers document a "history of" a condition that the patient is actively being treated for.I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
Hi LisaI work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?
I work in Urology too, we discussed this issue at one of our coding meetings. We use Z08 or Z09 depending on what the patient is seen for. Z08 w/ Z85.46 or Z09 w/ z87.442, Z87.440 etc. I haven't heard of any denials since doing this. If there is no hx code then we code z09 and whichever N or R code that pertains to the documentation.I work in Urology and we have patients that come in the clinic that have a personal history of a problem ,such as history of UTI, Kidney stone, cancer , basically all "Z" codes, and the Z codes are the primary and only DX code assessed. Cigna is denying all of the Z codes as cannot be used as a primary DX code. When we researched them, the only documentation we can find is that the codes cannot be used as primary for Inpatient ONLY. I'm stumped about what to do since the patient comes in for a yearly follow up only. I've reviewed the HPI and the only thing discussed is previous problems that they are not currently having. They are only under surveillance. Any suggestions? Has anyone found a Cigna policy that addresses Z codes?