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Wiki Horizon NJ Direct Denial

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Biller2023

Networker
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Location
Trenton, NJ
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Horizon NJ Direct keeps denying for the reason CO-16 (Claim/service lacks information or has submission/billing error(s) which is needed for adjudication) and Remark Code M76 (Missing/incomplete/invalid diagnosis or condition)
Claim was billed with 99215 with DX F07.81 (postconcussional syndrome) & S06.0X0D (Concussion without loss of consciousness,subsequent encouter). Please let me know what needs to be corrected. Thank you.
 
Athlete2023 said:
Horizon NJ Direct keeps denying for the reason CO-16 (Claim/service lacks information or has submission/billing error(s) which is needed for adjudication) and Remark Code M76 (Missing/incomplete/invalid diagnosis or condition)
Claim was billed with 99215 with DX F07.81 (postconcussional syndrome) & S06.0X0D (Concussion without loss of consciousness,subsequent encouter). Please let me know what needs to be corrected. Thank you.
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If you review the excludes1 notes under these ICD-10 codes, I think you'll find that the two shouldn't be coded together - most likely that's what's causing the denial. But you'd need to review the documentation to be able to know what correction is needed.
 
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