Wiki ICD-10-CM Updated Guideline

[brandimaywald]

We are a pediatric practice and recently started to receiving denials from Cigna and BCBS on our Well Checks and Immunizations. They are stating the the diagnosis used cannot be primary, we have been billing this way since implantation with out issues.

ICD-10 (Z23) is being used for immunizations.
ICD-10 (Z00) - is being used for the well check (depending upon the child's age)

I found a Medicare edit that has these listed as an unacceptable primary diagnosis. My questions is, how to code going forward as these patients coming in do not have a chief complaint but are there only for a wellness visit.

Is anyone else experiencing this issue?

 

[crystaljos]

We are a pediatric practice and recently started to receiving denials from Cigna and BCBS on our Well Checks and Immunizations. They are stating the the diagnosis used cannot be primary, we have been billing this way since implantation with out issues.

ICD-10 (Z23) is being used for immunizations.
ICD-10 (Z00) - is being used for the well check (depending upon the child's age)

I found a Medicare edit that has these listed as an unacceptable primary diagnosis. My questions is, how to code going forward as these patients coming in do not have a chief complaint but are there only for a wellness visit.

Is anyone else experiencing this issue?

The MCE (Medicare code Edit) is only applicable for IPPS, and not applicable for OPPS, thus please query payer on this, since this "unacceptable PDX" notation that is there for this ICD in the book is not applicable for out patient Please correct me if I am wrong

 

[thranowski]

I am also a pediatric office. I haven't gotten any denials from BCBS or for Z00.12X, but for Cigna for some reason they updated their system to deny Z23 as primary. They fixed it in their system, but as far as I know they aren't going to go back and fix their own mistake with the denials, so we have to call or send a reconsideration online for each visit that was done within their error period. That's what a Cigna rep told me.