Question Excludes 1 Denials Z01.419/Z30.41

Messages
5
Location
Frankfort,Il
Best answers
0
We currently have a diagnosis edit tool that is flagging GYN preventative visits billed with DX Z01.419 and Z30.41 as having an excludes 1 relationship. We're also receiving denials from some commercial plans for this same reason. ICD-10 lists Z01.4 as excludes 2 with Z30.4 , meaning they can be billed together if supported by documentation. Anyone else experiencing this, and have you had success with appealing the denials?
 

pspears

Contributor
Messages
16
Best answers
0
Yes, some of the payers are denying claims when contraception codes such in the Z30.4 series when they are billed with Z01.411/Z01.419. The guidelines clearly say they can be billed together which is why the excludes 2 note is listed under the Z01.411 section. But the payers make their own guidelines as well. So, yes you are not alone.
 
Top