Wiki G89.29 primary diagnosis denial

fltbaroque

Guru
Messages
131
Location
Longview, TX
Best answers
1
We got a denial for our pain management provider that states "diagnosis inconsistent with procedure code". We billed G89.29 as the primary diagnosis for 99204. This is a BCBS medicare advantage plan. Has anyone else had this issue?
Thanks
 
We got a denial for our pain management provider that states "diagnosis inconsistent with procedure code". We billed G89.29 as the primary diagnosis for 99204. This is a BCBS medicare advantage plan. Has anyone else had this issue?
Thanks
I would read the guidelines on pages 13-14 of the ICD-10 manual for correct coding. In general, G89 codes are only supposed to be primary when the reason for the visit is for pain control/management.
 
Hi Flt :)
Yes pain can be for numerous underlying reasons. This needs to be query to provider as reason for the pain. Is it due to a chronic condition in which the provider documented those words? In the front of the ICD10 manual in Chapters 6-sections A-C pg G14 states must have underlying reason and documented differ reasons in G89 dx blocks.. Insurance payer not paying for what is causing pain till you tell them. Also all kinds of pain related to psych problem, Cancer, Etc. I know some of the psych therapist list pain but we reminded them tell us reason; old war wound, PTSD, =dx G89.4 . And Cancer Pain= G89.3 or back or limb pain M25 and G89.29 once documented then can code it.
Well I hope helped you!
Lady T🩹(y);)
 
Top