Missing/incomplete/invalid diagnosis code

[slc112071]

Is anyone else having issues with getting denials for the use of M06.89 or L40.59 as primary diagnosis codes on office visits or injection services, mainly Toradol?

 

[nickelclaw]

insurance companies are trying to stop the use of unlisted/unspecified dx's.
See if there is an other instead of NOS/unspecified code.
Need to code as specific as possible including laterality

 

[slc112071]

With RA or changes from visit to visit if they are seropositive or not. Also, you don't have it in just one joint, it is systemic.

 

[slc112071]

I have even used M05.89 specific for seropositive RA and still getting denials for office visits from BCBSTX. Is anyone else having this issue?

 

[TThivierge]

Hi Slc112071,
The insurance company probably wants each body part instead of M06.89. look at the dx block of M06 ...was the RA on hip, knee ,elbow, ankle, feet,shoulder or hand. Also ensure use modifier of RT or LT on claim too along with detailed body area of Rhem. Arthritis documented in the medical notation.
I hope this data helped you.
Lady T

 

[slc112071]

Hi Slc112071,
The insurance company probably wants each body part instead of M06.89. look at the dx block of M06 ...was the RA on hip, knee ,elbow, ankle, feet,shoulder or hand. Also ensure use modifier of RT or LT on claim too along with detailed body area of Rhem. Arthritis documented in the medical notation.
I hope this data helped you.
Lady T

The thing with that is that RA is systemic. It normally does not affect just one area. I have RA so I know how much it hurts. I had no issues until August and they flipped a switch. I have also been having issues with them paying for Saphnelo. They kept telling me that I could only bill with 2 units.