Wiki Denial with carotid artery stenosis

[SMorris13]

I am trying to figure out why this particular claim denied. We are the patient's PCP, so this is outpatient. Pt was seen for a hospital follow up after a stroke. Patient was also documented as having bilateral carotid artery stenosis (confirmed by imaging) but this was not stated to be the cause of the stroke. The E/M billed is 99213 and the diagnoses are listed as I65.23, Z86.73, and D64.9. The denial remark was N432, not covered with this procedure. My manager says that a more specific diagnosis code should be used. What am I missing here?

 

[ellis3350]

If this was a hospital F/U after stroke, would dx Z09 be first and then Z86.73, I65.23, D64.9? I don't code primary care, so I'm just guessing without knowing the whole hx.