Pregnancy ICD 10

Mmawad

Contributor
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Greetings,
I am having issues with United Healthcare denying claims for routine glucose tests when a patient comes in for a nurse visit.

I usually code the following:

99211
82950

DX: Z34.90

For some reason, they are the only payor that has issue with this as a primary code.

Thoughts?

Thanks in advance,
Mark A. (COBGC Cert In Progress)
 

thomas7331

True Blue
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5
UHC commercial policy lists 82950 as a covered preventive benefit for pregnancy (see policy document at link below, page 35), and Z34.90 is included on their attached list as an accepted pregnancy diagnosis code, so I don't know why they would be denying this. But UHC administers a wide range of plans, also including state-specific Medicaid plans and company-specific self-insured plans which may have their own unique benefits and guidelines, so it's hard to say definitively why they would be doing this. I'd recommend looking at the types of plans where you are seeing the denials to see if there is a particular trend, and if so, you could review the coverage of those plans for specific coding guidelines. You may also wish to try using an antepartum screening diagnosis (e.g. Z36.89) rather than a supervision of pregnancy diagnosis as that might more accurately reflect the reason for this test. Hope this helps some.

 
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