T84.50XA

mtsoldevila

Networker
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28
Location
McKinney, TX
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I work for an Infectious disease clinic. Dr. billed T84.50XA as the primary and only dx for an office visit (POS 11), and insurance denied for: Per cpt guidelines , this service is not appropriate in this setting (pos). 58 treatment was deemed by the payer to have rendered in an inappropriate or invalid place of service.
Im thinking its because I should bill as T84.50XD , and not with an A as the 7th character? Can someone help me with this.
 

TThivierge

Expert
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Location
Lithonia, GA
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Hi Mtsoldevila,
The reason you get a denial is the insurance company needs more information as primary definitive illness or condition caused T84 to be used.. Which joint was infected that got the prosthesis? Also did the doctor do lab test to find out which type of infection it is? If you do not have that info add dx B96.89 too. But check the dx blocks of B95-B97 to be exact if given that data from lab report or doc s notations. The ICD10 manual states must add infection and primary dx with T84.50XD. Also last dx on claim look at block Z96 per affected limb. Check out dx blocks of M24.361 is knee but other body limbs which applies .See dx blocks M12.4 or M60.17, M86or M01.X61 if this applies from doc s documentation as one of primary dx codes, then add T84 block. Ensure it matches claim because insurance may want med records sent later.
I hope this information helps you.
Lady T:)
 
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