Wiki need help w/ Dx code

[jkh429]

So I have a situation w/ Medicare. Our provider billed out a Dx code of 605 with a 99203 CPT code. Medicare denied this as unprocessable stating that the diagnosis is inconsistent with the procedure. When I spoke with them, Medicare told me the diagnosis needed to be more specific. There is not a more specific code. My provider then tried to bill it as a Dx code of 607.9 but got the same denial. Does anyone know of anywhere that it states these Dx codes can not be billed with an office visit? Thanks

 

[mitchellde]

605 is a perfectly acceptable dx code, you might check your patient gender and be sure you have male and the payer has the patient as a male. Otherwise appeal and make a copy of the page in the codebook for this code.

 

[jkh429]

Thanks Debra! I feel like an idiot now lol. They put him in a female downstairs. At least it's an easy fix

 

[mitchellde]

LOL! It was the only thing I could think of!