Wiki Denial - Principal diagnosis inappropriately coded.

[JesseL]

I have a in-office claim denied as Principal diagnosis inappropriately coded.

Claim was billed as below

99213
dx T20.29XS, L81.0, D23.4

I can't figure out what they mean by "Principal diagnosis inappropriately coded."

 

[JesseL]

okay I think I know why..

Note says this..

Burn of 2nd deg mul sites of head, face, and neck, sequela
Healing skin, no more blisters, some erythema located on eyelids and face
Medical Decision Making: Burn of 2nd deg mul sites of head, face, and neck, sequela , problem
improved
POC: Recommendation is No need for more treatment. Likely with just some scar gels like mederma skin
will continue to improve in appearance. continue sun protection.

Should the dx be L53.9 then T20.29XS?

 

[CodingKing]

Should the dx be L53.9 then T20.29XS?

Yes. Per ICD-10-CM guidelines

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf

I.B.10

A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury. Examples of sequela include: scar formation resulting from a burn, deviated septum due to a nasal fracture, and infertility due to tubal occlusion from old tuberculosis. Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second.

An exception to the above guidelines are those instances where the code for the sequela is followed by a manifestation code identified in the Tabular List and title, or the sequela code has been expanded (at the fourth, fifth or sixth character levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect.

 

[mitchellde]

okay I think I know why..

Note says this..

Burn of 2nd deg mul sites of head, face, and neck, sequela
Healing skin, no more blisters, some erythema located on eyelids and face
Medical Decision Making: Burn of 2nd deg mul sites of head, face, and neck, sequela , problem
improved
POC: Recommendation is No need for more treatment. Likely with just some scar gels like mederma skin
will continue to improve in appearance. continue sun protection.

Should the dx be L53.9 then T20.29XS?

This does not read like sequela though. The provider states the burn area is healing, not that has healed with a residual condition such as a scar. The erythema would be a natural state of a healing burn so I would code the burn with a D and not an S and no other code needed.

 

[JesseL]

Thank you