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Wiki DENIED FOR MISSING/ INCOMPLETE/ INVALID OTHER DIAGNOSIS

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demata3

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Dr. billed a 99213 with M17.11, M17.12, M25.561, M25.562. It was denied, use Bilateral code. Sent it back M17.0, M25.561, M25.562 as there is not a bilateral knee pain code and was denied again for same reason. Should I just remove the knee pain diagnosis codes all together? Is it implied with M17.0 and not needed? When I called BC, she told me to add a Bilateral modifier to 99213?!?!?! Did I miss an update? Is that a thing now? I cannot do that.
 
LisaAlonso23 said:
Per the ICD-10 guidelines, you are not to code symptoms when you have a definitive diagnosis.
Click to expand...

Agreed - I wouldn't include knee pain with osteoarthritis. The arthritis is the disease - knee pain is a symptom of that.
 
Have you considered that the bilateral denial is actually for your codes M17.11 - Unilateral primary osteoarthritis, right knee and M17.12 - Unilateral primary osteoarthritis, left knee, which does have a bilateral code M17.0 - Bilateral primary osteoarthritis of knee?
 
CBLENNIE said:
Have you considered that the bilateral denial is actually for your codes M17.11 - Unilateral primary osteoarthritis, right knee and M17.12 - Unilateral primary osteoarthritis, left knee, which does have a bilateral code M17.0 - Bilateral primary osteoarthritis of knee?
Click to expand...
Agree with all above. This is the bingo!
Remove pain codes as advised, do not code signs/symptoms when there is a definitive dx.
Change the RT/LT dx to the M17.0 only.
Don't listen to reps that tell you to add a 50 modifier to an E/M. (LoL)
 
amyjph said:
Agree with all above. This is the bingo!
Remove pain codes as advised, do not code signs/symptoms when there is a definitive dx.
Change the RT/LT dx to the M17.0 only.
Don't listen to reps that tell you to add a 50 modifier to an E/M. (LoL)
Click to expand...

That's an excellent example of where a rep should have stuck to the standard line "I can't tell you how to code your claim." :LOL:
 
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