Wiki Denied claim d/t diagnosis problem

[erjones147]

I'm relatively new to chiro billing for Medicaid, but I still can't understand why this claim was denied after it had been paid previously many times for the exact same info:

Dx: 722.51, 722.4, 722.52, 739.1
CPT: T1015 (we have a special contract for Medicaid)

Error code: M64 - missing, incomplete, invalid diagnosis

 

[mitchellde]

Check your codes for exclusions

 

[erjones147]

no exclusions that I can find

 

[mitchellde]

Did you check the code book at the main category heading? I thought there were exclusions for these codes

 

[erjones147]

There's nothing at the beginning of Chapter 13 that I could see; maybe I'm looking in the wrong place. The dorsopathy and chrondropathy exclusions do not apply.

Probable false alarm, anyway - our biller checked with HP, and they said they would research, but they think the denial is wrong

 

[ejlehman]

More than likely it is a glitch in their system. We have been having lots of issues with those lately.

 

[gray4724]

check for mods or medical necessary

 

[debipbarik]

722.51 is invalid

I'm relatively new to chiro billing for Medicaid, but I still can't understand why this claim was denied after it had been paid previously many times for the exact same info:

Dx: 722.51, 722.4, 722.52, 739.1
CPT: T1015 (we have a special contract for Medicaid)

Error code: M64 - missing, incomplete, invalid diagnosis

Only code 722.4,722.52,739.1 . here code 722.51 is invalid as 722.4 includes Thoracic location also . Check description in tabular list of 722.4. Correct me if i am wrong. i am new to AR coding.

 

[sholtzclaw6]

I have been billing for chiropractic for the past eight years. When I get that denial code there are a few things I check. First the diagnosis and procedure codes if those are valid look at the spelling of the name if it matches the name on the insurance card as well as date of birth. Lastly I check the id number to make sure it was typed in correctly. If all of these are correct try resubmitting the claim, it could have been wrongly been denied.