Wiki Kyphoplasty

[mfries@emapugetsound.com]

UHC is denying payment on 22514 and 22515 Cpt codes billed with M80.08XS as a primary diagnosis. Denial reason is "Invalid primary dx code". Per CMS website the diagnosis code is good. Any ideas?

 

[carlystur]

A sequela encounter code cannot be primary, per coding guidelines. Is there a sign/symptom that the provider is addressing who believes that originates from the sequelae?

Per Section I B (Sequela) Late Effect: "Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second." Do you have a condition/nature of the sequelae available to be coded first? If not, I would send an inquiry to the provider.

 

[LisaAlonso23]

If the patient is still in active treatment, the 7th character should not be an S.

 

[pinnaclephyserv]

We are billing S32.020A Medicare denial "Not Medically Nec"