UHC MEDICARE REJECTION

trarut

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What reason are they giving for the rejection? Also, W55.81A is not a valid code so if that's what is on the claim, it could be the problem.
 

trarut

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None of the codes are flagged as not being a primary diagnosis and I don't see any Excludes1 notes that precludes them from being used together.
Can you provide a de-identified note (or the pertinent parts) for the encounter? You may get more responses if we have more information to go on.
 

iowagirl77

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Was W55.81XA listed as the primary diagnosis? If so, then I'd say that is your issue. An external cause code should never be listed as the first diagnosis.
 

trarut

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Oops, my mistake on my previous response. I relied on Coder to advise on this one but should have checked the guidelines myself. Thanks, iowagirl77 and ndanh01.
 
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