Wiki "emergent" lumbar disc herniation coding

Create Wiki
R

roussj19

Guest
Messages
17
Location
Asbury Park, NJ
Best answers
0
DX- L5-S1 disc herniation we coded as M51.17
procedure was a reop right l5-S1 discectomy, cpt 63042
appended modifier ET. this is a bluecross plan

we are having issues getting this paid because bcbs is stating the dx is for an illness/injury and is not classified as emergent. I have not been able to get any info off the bcbs bulletin and am having trouble finding anything else so, figured I would post on here. Any input would be appreciated thank you!
 
Disc herniation with radiculopathy alone is not an emergent case. Does the chart state any other conditions caused by the disc herniation/radiculopathy? It can be emergent, but the documentation needs to state exactly why. If it doesn't, you cannot win the appeal.
 
You must log in or register to reply here.
Top