Wiki Unspecifid Dx

[Lliza71]

Good Morning,

I've just found out that there are certain "unspecified" dx codes that Horizon BCBSNJ will not cover. I have 2 inpt visits by our hospitalist for a pt w/the following dx codes:

852.06 subarachnd hemorrhage following injury, w/o mention open intrcrnl wound, loss of consciousness unspecified duration
276.3 alkalosis
288.60 Leukocytosis unspecified

Horiz denied 852.06 and 288.60. Said they don't cover unspcfd codes (as per our AR rep). Nowhere in the med record mentions how long pt was unconscious. (Also E006.0 used)

Does this sound right? And if so, does anyone know if there really is a specified dx list of these non-covered codes? Or where to find them? I've searched but don't find anything regarding this.

I'd appreciate your help! Thanks!

Liza

 

[cjhalk@yahoo.com]

I am curious about 803.22
Closed skull fracture with subarachnoid/subdural demorrhage, brief unconsciousness.

I'm looking at this from a CPT time based code. So many if not all time based codes require a mention of time and if no mention of time, falls to the lowest CPT code.

803.22 is less then one hour. why can't you use the lower possible time code for a patient that you know had unconsciousness.

I am assuming the patinet doens't have leukemia in regards to the Leukocytosis.would you be able to post some more information on this diagnosis. Something in the body of the note that the doctor decided to give this diagnosis. Any lab results mentioned in the body of the note?