Wiki Claim denials for ultrasound

[patdow]

We have received 3 denials for a claim for an ultrasound. Originally, we billed it with K75.9 then B19.10. CPT code 93975 and 76700 with modifier 59. We use these CPT codes daily with that modifier without issues. It was denied due to “Claim/service lacks information or has submission/billing error(s) which is needed for adjudication” and “The diagnosis code(s) submitted is inconsistent with ICD 10 coding guidelines”.

We then changed ICD 10 to B19.10 primary then K75.9. Line 76700 paid. 93975 denied for same reason as before.

Line 93975 was updated with ICD 10 codes R74.01, B19.10, and K75.9. It denied for same reason as before.

Do we just need to remove the K75.9 code even though it’s not primary anymore?

 

[sls314]

We have received 3 denials for a claim for an ultrasound. Originally, we billed it with K75.9 then B19.10. CPT code 93975 and 76700 with modifier 59. We use these CPT codes daily with that modifier without issues. It was denied due to “Claim/service lacks information or has submission/billing error(s) which is needed for adjudication” and “The diagnosis code(s) submitted is inconsistent with ICD 10 coding guidelines”.

We then changed ICD 10 to B19.10 primary then K75.9. Line 76700 paid. 93975 denied for same reason as before.

Line 93975 was updated with ICD 10 codes R74.01, B19.10, and K75.9. It denied for same reason as before.

Do we just need to remove the K75.9 code even though it’s not primary anymore?

K75.9 has an Excludes1 for Viral Hepatitis B15-B19.9.

Think about it this way - K75.9 is Inflammatory liver disease, unspecified. Does that code add any clarity to the picture of a patient encounter for viral hepatitis? No. The patient has viral hepatitis - there's no reason to add a code for "unspecified inflammatory liver disease." (Although K75.9 can also mean Hepatitis NOS, this patient's hepatitis isn't Not Otherwise Specified. It's Viral Hepatitis, and you've already assigned a code for that.)

 

[patdow]

K75.9 has an Excludes1 for Viral Hepatitis B15-B19.9.

Think about it this way - K75.9 is Inflammatory liver disease, unspecified. Does that code add any clarity to the picture of a patient encounter for viral hepatitis? No. The patient has viral hepatitis - there's no reason to add a code for "unspecified inflammatory liver disease." (Although K75.9 can also mean Hepatitis NOS, this patient's hepatitis isn't Not Otherwise Specified. It's Viral Hepatitis, and you've already assigned a code for that.)

View attachment 7701

Thank you. Do you know why line 76700 would pay with K75.9 as primary and 93975 would not pay with it as primary or as a third code?