Denials from medicaid

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Hello,

I have run into an issue with Medicaid stating that

1) L21.0 has an age limit. This I don't understand because this is a code for Dandruff and anyone can get dandruff at any age? However there are no other appropriate codes to assign to this patient from the medical record.

2) E55.9/E55 is not a valid code- however the patient is simply Vitamin D deficient, and medicaid will not accept it as "unspecified"

Has anyone else run into these problems?

TIA:rolleyes:
 

Pam Brooks

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L 21.0 is not the code for dandruff. It is cradle cap, typically a condition found in babies. That's why there is an age limit. It's right in the book.

E55.9 is Vitamin D deficiency, NOS. There's no other code, unless the provider documents Rickets. I've not found many payers that cover your generic vitamin deficiencies.
 

thomas7331

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L 21.0 is not the code for dandruff. It is cradle cap, typically a condition found in babies. That's why there is an age limit. It's right in the book.
In my encoder and code book, the Index to Diseases does direct to L21.0 from 'dandruff', but I also do see that L21.0 is designated as a pediatric code. I'm wondering if this is an error in the index that needs to be corrected, what do you think?
 

jennyjenn75

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Dandruff vs. Cradle Cap

I can see where this confusion stems from. In the alphabetic index Dandruff indicates L21.0, but in reality, it should have just said L21. There are L21.8 and L21.9 that I think refer to dandruff in adults...:confused:
I think this was a mistake and the alphabetic index should be edited.
 
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