Wiki COVID Z20.822

demoore6

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Hello,
Since Z20.822 has replaced Z20.828, if I receive a requisition that has the Z20.828, am I able to change the code to Z20.822 without contacting the physicians office since it is being replaced?

Thank you
DMoore
 
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Z20.828 has not been replaced, it is still a valid code. Z20.822 was added as a new code that is more specific.

If you have documentation from the provider as to why the test is being ordered, then you can assign the appropriate code, but if all they've given you is a code, then how can you know that is or isn't correct?
 
Z20.828 has not been replaced, it is still a valid code. Z20.822 was added as a new code that is more specific.

If you have documentation from the provider as to why the test is being ordered, then you can assign the appropriate code, but if all they've given you is a code, then how can you know that is or isn't correct?
Thank you for the reply. Our coder is out and I am unsure on some of the coding questions being asked of me. So again thank you. I am sure I will have more questions.
 
What services were billed and what is the reason for the denial? Without knowing more detail, it's hard to make any recommendation for a resolution.
Covid screening tests like PCR antigen biofire etc. They are paying in case of symptomatic patients . For asymptomatic patients where z20.822 is billed as primary . Cigna is denying claims
 
Reason of denial is unacceptable primary ICD
The code is acceptable as a primary diagnosis per ICD guidelines. It may just not be acceptable to Cigna or to the member's benefit plan. I'd suggested contacting Cigna with a few examples and discussing it with them. It may be that the service is simply not a covered benefit under certain plans for asymptomatic patients, in which case the patients would be responsible. But if they insist that you are billing the code incorrectly, I'd ask to see their written policy to see where and why it states that and how they want you to bill instead. It may be necessary to escalate the inquiry if your first contact is not able to give you a satisfactory answer. Hope this helps some.
 
The code is acceptable as a primary diagnosis per ICD guidelines. It may just not be acceptable to Cigna or to the member's benefit plan. I'd suggested contacting Cigna with a few examples and discussing it with them. It may be that the service is simply not a covered benefit under certain plans for asymptomatic patients, in which case the patients would be responsible. But if they insist that you are billing the code incorrectly, I'd ask to see their written policy to see where and why it states that and how they want you to bill instead. It may be necessary to escalate the inquiry if your first contact is not able to give you a satisfactory answer. Hope this helps some.
Thanks
 
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