Horizon Denials for dx mismatched

[klamond]

We have been receiving numerous denials from Horizon for established pt E&M codes such as 99214 for "diagnosis codes associated to it are mismatched per the ICD-10-CM Official Guidelines for Coding and Reporting". From what I can see the dx codes always have the correct suffix, laterality is specific, there are no excludes 1 notes between them. An example would be S83.272A with M17.0 billed for CPT 99214. I have researched the official guidelines on CMS but can't find anything regarding this issue. What am I missing? Any input would be greatly appreciated.

diagnosis codes, diagnosis coding

 

[haraml7]

We have been receiving numerous denials from Horizon for established pt E&M codes such as 99214 for "diagnosis codes associated to it are mismatched per the ICD-10-CM Official Guidelines for Coding and Reporting". From what I can see the dx codes always have the correct suffix, laterality is specific, there are no excludes 1 notes between them. An example would be S83.272A with M17.0 billed for CPT 99214. I have researched the official guidelines on CMS but can't find anything regarding this issue. What am I missing? Any input would be greatly appreciated.

Did the tear cause osteoarthritis? Is this tear the patients first tear of this muscle or ligament.

These 2 codes, in my opinion, kind of contradict each other due to a tear is an acute issue, initial incident, and osteoarthritis is something that happens with time with several tears of muscle or ligament.

Do you have the remark codes on the remit to identify exactly why they are denying these 2 DX codes?

I hope this helps

diagnosis codes, diagnosis coding