Wiki D18.01 and D22.9 Denial

[atmcgaugh@gmail.com]

I work at a Dermatology clinic where D18.01 (angioma of skin) and D22.9 (melanocytic nevi) are used quite frequently on claims within the same office visit. We have received a lot of push back lately for reimbursement on office visits 99202-99204 and 99212-99214 When both codes are billed alongside eachother stating DX codes do not meet criteria. We are not having this issue with Medicare it does not seem. Just comercial insurance plans. Has anyone else been seeing this problem or know where the issue lies? TIA

 

[sls314]

I work at a Dermatology clinic where D18.01 (angioma of skin) and D22.9 (melanocytic nevi) are used quite frequently on claims within the same office visit. We have received a lot of push back lately for reimbursement on office visits 99202-99204 and 99212-99214 When both codes are billed alongside eachother stating DX codes do not meet criteria. We are not having this issue with Medicare it does not seem. Just comercial insurance plans. Has anyone else been seeing this problem or know where the issue lies? TIA

There's an Excludes1 note between those 2 codes - you shouldn't be using them together.

D18.- category has an Excludes1 note for D22-D22.9. Do you have an ICD-10-CM book? I would suggest looking at the Excludes notes for D18.-

 

[jamy1528]

We are seeing the same in our practices and the physicians do not understand the clinical logic behind why they cannot code an angioma of skin and melanocytic nevi at the same time. I understand what an Excludes 1 note is but can't explain the logic behind it. Does anyone understand why these two diagnosis cannot be coded at the same time? If they are on two different sites, can we appeal with medical records?

 

[Cbaxter001]

I believe you need to use a more specific D18- diagnosis code for it to be billed with D22.9, and probably link each diagnosis to it's specific procedure

 

[sls314]

We are seeing the same in our practices and the physicians do not understand the clinical logic behind why they cannot code an angioma of skin and melanocytic nevi at the same time. I understand what an Excludes 1 note is but can't explain the logic behind it. Does anyone understand why these two diagnosis cannot be coded at the same time? If they are on two different sites, can we appeal with medical records?

The CDC would be the official source for the rationale on why Excludes1 notes exist between 2 codes. I really can't speculate on that.

The CDC has an email address for the ICD-10-CM Coordination and Maintenance Committee: nchsicd10cm@cdc.gov

Your provider can use that email address to get the rationale for the Excludes1 and/or request that the Excludes1 note be reviewed for a future year's update.

https://www.cdc.gov/nchs/icd/icd-10-cm.htm