Q/A: What’s Wrong with the Diagnoses on my Claim?
April 22nd, 2019 - Wyn Staheli, Director of Content
Question:
I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
Answer:
Code M79.2 “Neuralgia and neuritis, unspecified” is listed as an “Excludes1” for all M54.1- codes (Neuralgia and neuritis NOS) which means that it can NOT be coded with M54.15 — no exceptions. This is why it is so important to review Includes and Excludes information for diagnosis codes. While cheat sheets are helpful, they don’t generally include this level of information. You need to understand the coding rules and that means reviewing Includes and Excludes (Excludes1 and Excludes2).
Also, don’t forget to review the Excludes for the main categories. For example, M50-M54 has an Excludes1 for “discitis NOS (M46.4-)” so you can’t use any of the codes in this category with M54.15.
Payers are following these official ICD-10-CM rules when processing claims so you need to make sure you are checking the Tabular List for this very critical information.
The ICD-10-CM Coding for Chiropractic book includes the Tabular List. Also, those with a FindACode.com subscription can see all the Includes and Excludes at the code level — going all the way back to main categories so it’s extremely helpful to make sure you don’t miss anything.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn StaheliCOVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?October 10th, 2023 - Aimee WilcoxWhen EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM CodesOctober 5th, 2023 - Aimee WilcoxCoders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin ResistanceSeptember 19th, 2023 - Aimee WilcoxDiabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative VisitsSeptember 12th, 2023 - Aimee WilcoxSometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?
Understanding Gastroesophageal Reflux Disease and ICD-10-CM CodingAugust 22nd, 2023 - Aimee WilcoxGastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.
