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Wiki new pediatric provider in office

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Kzollinger85@yahoo.com

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Marmaduke, AR
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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
 
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?
 
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?
 
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