Wiki ICD 10 DENIALS

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MLITE2113

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I work for a Multi Speciality practice and our physicians love to use Radiculopathy as a primary DX. Whether it's Lumbar or Cervical. Never had any issues with payments.
Now we are receiving denials from Medicaid and Medicare payers stating missing/incomplete/invalid diagnosis or condition.
I called the insurance company and was told it was the combination of 2 codes that were billed. (Here is just one example)
M51.16- Intervertebral Disc disorder with Radiculopathy Lumbar
and
M54.12- Radiculopathy Cervical
Can someone help me with links that would help our coders determine how/where the insurances companies are flagging invalid codes and/or code combos.
It's almost like CCI edits on DX codes.

Any help is appreciated!
Thank you all!
 
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Yes we are billing what is on the LCD's exactly. It must be the combination of codes that we are billing that is causing the issue.
I had another denial today for a trigger point injection billed with
M60.88 and M79.81 together both codes are payable on our LCD but, denied with the same denial.
 
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For the first set of diagnoses, there is an excludes 1 note when you look at the M54.1- codes. For the second set of codes, I cannot find an issue so I'm not sure why those would deny.
 
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