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Dx 257.9

  1. #1
    Default Dx 257.9
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    Please help!

    We are billed dx 257.9 for a child. The patients Medicaid Mgd Care Plan keeps denying the claims stating that the dx is not consistent with the patients age. I have called and asked them to review. They still deny the claim. The ICD-9 book does not have an age range for this code. Has anyone else experienced this? Or have anything that can help me to get our claims paid?


  2. Default
    Are you sure that they are complaining about the Dx code and not the CPT code?
    Some of my doctors can't do math and give us the wrong preventive medicine codes LOL (wrong age group).
    Also, some insurances don't like billers to use the "unspecified" codes as a first listed diagnosis. They want a more specific code. Ask the doc if he can be more specific.

    Other than that, you are correct - I don't see an age limit on that code either. Children can have testicular dysfunction too.

  3. #3
    Columbia, MO
    perhaps based on age of the patient they are wanting a code from the congenital chapter.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Thanks! No they are specifically denying the CPT code. I will check the congential section and query the doctor.

    Thanks for your help

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