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need help w/ Dx code

  1. #1
    Question need help w/ Dx code
    Medical Coding Books
    So I have a situation w/ Medicare. Our provider billed out a Dx code of 605 with a 99203 CPT code. Medicare denied this as unprocessable stating that the diagnosis is inconsistent with the procedure. When I spoke with them, Medicare told me the diagnosis needed to be more specific. There is not a more specific code. My provider then tried to bill it as a Dx code of 607.9 but got the same denial. Does anyone know of anywhere that it states these Dx codes can not be billed with an office visit? Thanks

  2. #2
    Columbia, MO
    605 is a perfectly acceptable dx code, you might check your patient gender and be sure you have male and the payer has the patient as a male. Otherwise appeal and make a copy of the page in the codebook for this code.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thanks Debra! I feel like an idiot now lol. They put him in a female downstairs. At least it's an easy fix

  4. #4
    Columbia, MO
    LOL! It was the only thing I could think of!

    Debra A. Mitchell, MSPH, CPC-H

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