Question Z02.89 denials

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Amity, OR
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We help a lot of refugees at our clinic and our providers keep using Z02.89- Encounter for other administrative examinations as the Primary DX for their initial Refugee Health Visit. Medicaid keeps denying all of our claims though for "This service is not covered under your plan." I called Medicaid and they could not come up with a reason for why these claims are getting denied and told me they would get back to me in 60-90 days. Is there a different code we should be using? We have had well over 100 claims be denied due to this one DX code. Any idea why?

Thank you.
 

TThivierge

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Atlanta, GA
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We help a lot of refugees at our clinic and our providers keep using Z02.89- Encounter for other administrative examinations as the Primary DX for their initial Refugee Health Visit. Medicaid keeps denying all of our claims though for "This service is not covered under your plan." I called Medicaid and they could not come up with a reason for why these claims are getting denied and told me they would get back to me in 60-90 days. Is there a different code we should be using? We have had well over 100 claims be denied due to this one DX code. Any idea why?

Thank you.
Hi Carleycarter, :)
I would not use Z02.89 as first dx code even though it is listed in the ICD10 manual. Your provider needs to document a detailed reason why the immigrant is seeking care. Is it due to flu J01 or allergies J31, thumb fracture S62.5, itchy skin L29, M54 backache ,pregnant 009.7, or has a sex disease A54, Hepatitis B18.2 . morning sickness O21.1, Mood DO F06 or ...some medical reasons? Then can add Z02.89. Insurnace payers want to know the medical rationale first . If it is for physical use the Z00 blocks per age of new or established patient linked with the CPT preventive health code.

Oh yes, most electronic data transmission clearinghouse computer systems are set by algorithms. This may be set up to automatic reject that if used as first dx code Z02.89.
I hope I helped you;)
Lady T
 

thomas7331

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We help a lot of refugees at our clinic and our providers keep using Z02.89- Encounter for other administrative examinations as the Primary DX for their initial Refugee Health Visit. Medicaid keeps denying all of our claims though for "This service is not covered under your plan." I called Medicaid and they could not come up with a reason for why these claims are getting denied and told me they would get back to me in 60-90 days. Is there a different code we should be using? We have had well over 100 claims be denied due to this one DX code. Any idea why?

Thank you.
I agree that Z02.89 is correct based on what you've described. I would not code these with CPT codes 99201-99215 though, because those codes are for problem-oriented visits that require a chief complaint. If this service is solely being performed as an administrative requirement, then those codes aren't correct, and I'd probably use unlisted code 99499 for this.

It's quite possible that Medicaid simply does not cover this service - many payers do not cover administrative exams because they are neither a covered preventive benefit nor are they a service done for the diagnosis or treatment of an illness or injury. Or if they do happen to cover it, they may require a specific HCPCS code in order to get payment and you'd need to find out what that is in order to bill correctly.
 

moonie

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We also had this issue with denials for our "New American" refugee exams for lab charges. Our MAC will now accept them but requires additional info. We contact the provider's office and ask if it is the initial or subsequent visit and send that info with the claim.
 
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