we received a denial for this dx code. The patient is 12 years old. Is there a different dx code rather than infantile CP? Not sure. Thanks.
Your code of 343.9 is correct for CP. What was the reason for the visit? Since the dx of CP was probably made many years ago, could the age of 12 on the claim with 343.9 as first listed dx be the reason for the denial?
It was a regular 99213 (don't have notes) but the ins rep said the dx code was the reason for the denial. That makes me think medical necessity since it is a valid dx code. It could be the ins co just 'busting chops' but wanted to make sure the 343.9 was correct for the patient's age. Thanks.
Originally Posted by Mojo
For infantile CP â€“ the child should be in the early childhood age .
The termâ€ť infantâ€ť typically applied to children between the ages of 1 month and 12 months; however, definitions vary/extend between birth and 3 years of age.( ie early childhood), atleast for medical purposes.
Legally "Infant" is also used for referring to any child under the age of legal adulthood. But for our coding and medical purposes,the sentence I mentioned is the appropriate.
In our scenerio, the child has come for E/M service. If could not be for a infantile cerebral palsy as the reason for encounter. (S) he could have some late effects of the infantile cerebral palsy for eg from the code sets of 438.xx . If so,I feel that you could try to assign this as the prim listed.
If you could post the details may be we can figure it out better.
the term infantile in the dx infantile CP does not mean a disease restricted to age it is defined as a heterogeneous group of nonprogressive motor disorders caused by chronic brain injuries that originate in the prenatal period, perinatal period, or first few years of life. The payer should be contacted regarding a possible incorrect edit. The 438.x is incorrect for this scenario as those codes are for late effects of a CVA.
Debra A. Mitchell, MSPH, CPC-H