Wiki Denial for incmpl/invalid DX or condition

[JDuhaime]

I have been researching on why these claims were denied for the following Diagnoses and can't seem to see why. Would it be the unspecified convulsions?

I67.4 Hypertensive Encephalopathy

N34.2 Other Urethritis

G93.41 Metabolic Encephalopathy

R56.9 Unspecified Convulsions

What am I missing?

 

[thomas7331]

I67.4 is listed in the Excludes1 note under G93.4-, so G93.41 shouldn't be used in conjunction with that condition. I think that's likely the problem?

 

[JDuhaime]

I67.4 is listed in the Excludes1 note under G93.4-, so G93.41 shouldn't be used in conjunction with that condition. I think that's likely the problem?

That would make sense but on another claim I67.4, G93.40 instead of G93.41, R56.9 was billed and paid

 

[thomas7331]

That would make sense but on another claim I67.4, G93.40 instead of G93.41, R56.9 was billed and paid

It's possible the payer's edits aren't set up correctly. Or maybe you just got lucky that time - payers do make errors. It's really hard to say - what's happening on the payer's side could be anybody's guess. But other than the excludes1 note, I don't see any other issues with these codes.