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Wiki Horizon denying E&M for valid Dx codes

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klamond

Networker
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66
Location
Edison, NJ
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We have been getting numerous denials from Horizon for "mismatch of dx code and procedure code". They are valid dx codes (not missing a letter or number, etc) so not sure what the issue is. When we call, they just state you can't bill that diagnosis with 99213 . Example: M23.322 with 99213. Anyone else having this issue? Any input would be greatly appreciated. Thanks
 
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We have gotten some on surgeries. AVR 33405 with Aortic stenosis I35.0. Incorrect DX code. NO payment. Will bill hundreds of cases a year with that and to them. This was a first!
 
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