Wiki Diagnosis Code

[tmsjuly69@gmail.com]

We submitted a claim to a payer and the claim is being stopped at the front end edit, stating, " the diagnosis code B95.61 describes an external cause code or requires the diagnosis code for the first underlying disease, and should never be listed a the primary diagnosis for a procedure".

Would this be a diagnosis code we could use for the primary diagnosis?

L08.89 - Other specified local infections of the skin and subcutaneous tissue

​

L00-L99- Diseases of the skin and subcutaneous tissue

• L00-L08- Infections of the skin and subcutaneous tissue
  • L08- Other local infections of skin and subcutaneous tissue
    • L08.8- Other specified local infections of the skin and subcutaneous tissue
      • L08.81 - Pyoderma vegetans
      • L08.82 - Omphalitis not of newborn
      • L08.89 - Other specified local infections of the skin and subcutaneous tissue

​

 

[thomas7331]

The payer is correct - B95.61 cannot be a primary diagnosis. Per the section B95-B97 guidelines in ICD-10: "These categories are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere."

So what is the disease that the provider has documented for this patient? All code assignments require a provider statement of diagnosis. There's no way to tell what diagnosis code you can use without first knowing what the physician has documented.

 

[tmsjuly69@gmail.com]

The Impression/Plan is Staph Aureus

 

[tmsjuly69@gmail.com]

I also have to mention this is only for an office visit 99213

Thank you Thomas

 

[tmsjuly69@gmail.com]

Our practice management system also only had this diagnosis as a primary which is surprising, the system should know another code is required.