Wiki new pediatric provider in office

[Kzollinger85@yahoo.com]

provider billed 99223 for hospital admit
with
z38.00 newbord delivered svd
p12.81 caput succedanuem

ins denied say was not compatible with pt sex

 

[CBLENNIE]

Since neither of these DXs nor the CPT code are gender specific it sounds like a mistake was made when the insurance company processed the claim. Have you reached out to them to see if it was just a processing error and if not exactly what the denial is based on since none of the codes are gender based?

 

[amyjph]

Does the claim (or electronic version of the claim loop) have the M or F box correctly checked or is it blank? Are there other CPTs or diagnoses on the claim?
Not sure what this has to do with a new pediatric provider in the office?
Do you have any further information on the claim or denial? Was it a true denial or a rejection at a clearinghouse level?
Have you done the suggestion above and contacted the payer?