Wiki "diagnosis inconsistent with the procedure"

[adudms]

I am getting this message from one of our state medicaid MCOs in reference to the diagnosis code associated with an E/M CPT. the CPT is 99214 and the diagnosis code is Z33.2. What are the rules for pairing DX codes with CPT codes? I thought when an E/M is done, and a decision for surgery(minor) is made for the same day, the DX code for the procedure could be attached to the E/M code. Am I missing something?

 

[mitchellde]

Z33.2 Indicates the encounter is for elective termination of pregnancy, you would not do this with an office visit. If this is the visit for the decision to terminate then your patient is still pregnant. So you would use the pregnancy diagnosis. the visit for the procedure to terminate would be coded with the Z33.2

 

[wbrodsky]

Z33.2 Indicates the encounter is for elective termination of pregnancy, you would not do this with an office visit. If this is the visit for the decision to terminate then your patient is still pregnant. So you would use the pregnancy diagnosis. the visit for the procedure to terminate would be coded with the Z33.2

This is 100% correct