Question Does the ICD-10 Name/Description make the code INVALID?

Messages
3
Location
Canton, OH
Best answers
0
Hello, we are having Rejections and errors due to ICD-10 Codes coming over with different names/descriptions. IE M46.1 being Bilateral Sacroiliitis instead of Sacroiliitis, not elsewhere specified. We are even getting claims denied because of M54.16 being Radiculopathy of lumbar region instead of M54.16 Radiculopathy, lumbar region. Does the ICD-10 Name/Description make the code INVALID?
Does this make the Claim/ Doctor notes incorrect as well?
 

thomas7331

True Blue
Messages
3,897
Best answers
11
I have never heard of such a rejection or denial. As far as I'm aware, the code itself is the only thing that is transmitted on the claim. There is no place for a code name or descriptor on the claim form, so I don't see how a claim could reject for this reason. You may need to talk with your payer or your software vendor to get a more clear explanation of what is happening here.

As far as the doctor's note, a code is just a classification and the descriptor is not a diagnosis - it's just a name for that category. The provider's notes should state exactly what diagnosis the provider has given for the patient - it may or may not match the code descriptor, because most codes have multiple different diagnoses associated with them. Since the descriptor is just a name assigned for that classification, and should have no bearing on the notes or on the claims.
 
Messages
3
Location
Canton, OH
Best answers
0
I have never heard of such a rejection or denial. As far as I'm aware, the code itself is the only thing that is transmitted on the claim. There is no place for a code name or descriptor on the claim form, so I don't see how a claim could reject for this reason. You may need to talk with your payer or your software vendor to get a more clear explanation of what is happening here.

As far as the doctor's note, a code is just a classification and the descriptor is not a diagnosis - it's just a name for that category. The provider's notes should state exactly what diagnosis the provider has given for the patient - it may or may not match the code descriptor, because most codes have multiple different diagnoses associated with them. Since the descriptor is just a name assigned for that classification, and should have no bearing on the notes or on the claims.
I think you are right We are using ECW and no one seems to know how to fix or change anything and getting support from the vendor never works because they say it is our clearing house and the clearing house says it is ECW.
 
Last edited:
Top