Wiki Diagnosis is inconsistent with the procedure.

cris722

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I keep getting denials stating, "The diagnosis is inconsistent with the procedure."

99218 J11.1, J02.9
99217 J11.1, J02.9

also, 99213 J11.1, J02.9


Any advice as to why this is happening and what the solution to this would be greatly appreciated?
 
It's hard to say for sure without reviewing the full documentation and the payer's policies, but there is an 'excludes 1' note that states that influenza with respiratory manifestations should not be coded with the J00-J06 range and most likely J02.9 is inappropriate here. My guess is that the payer is enforcing this coding exclusion.
 
It's hard to say for sure without reviewing the full documentation and the payer's policies, but there is an 'excludes 1' note that states that influenza with respiratory manifestations should not be coded with the J00-J06 range and most likely J02.9 is inappropriate here. My guess is that the payer is enforcing this coding exclusion.
Thank you...this helps me because I honestly did not pay attention to the excludes 1 note and I should have.
 
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