Wiki T84.093S denied

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mtsoldevila

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I billed T84.093S as the only code for IP visit with CPT 99222. I know this code is exempt from POA reporting so it doesn't need a PA indicator code. What could be a reason for the denial? The denial says missing/incomplete/invalid principal dx. I didn't find this code in the not valid for principal dx either. Any ideas?
 
I have had a claim deny with the same reason when I used a Sequela code as the first listed code. Try coding something else first, such as a pain code, and then listing the sequela. The coding guidelines talk about sequela codes in a couple of places.
 
Why are you coding sequela. if the patient presented to the hospital with the mechanical complication you would code active. That could be the reason. if the patient has an infection you would have to code that infection first then the complication to the artificial joint
 
Sequela codes should not be used as a primary code. The issue that caused the sequela should be coded 1st and then the sequela code.
I also agree with the above statement from jlcheritage.
 
Yes, if there is a sequela (which there doesn't appear to be based on the minimal information you supplied) then per ICD-10-CM coding guidelines 1.c.19.a. you code the sequela first followed by the injury/other consequence of external causes T code.

If you just code an injury code that has a sequela with T84.093S then the claim will deny due to invalid primary DX. As others have said, it would be more reasonable to code as T84.093A anyway with A indicating initial encounter/active treatment.
 
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