Wiki Appropriate ICD 10 code w/cpt code

[AN2114]

I'm getting a denial from the insurance for billing T85.898A as the diagnosis for 69610. I have billed that diagnosis before and I've never had an issue. I've tried appealing it and they are still denying it. The insurance is saying "the specific code combination listed above was denied based on published evidence based coding literature." I'm trying to do some research to see if I can find anything that supports whether or not it's appropriate to use that icd 10 code. Does anyone have/know any resources that could help because I can't find any info regarding billing that diagnosis with that procedure.

 

[sls314]

What was the reason for the patient's surgery? T85.898A (Other specified complication of other internal prosthetic devices, implants and grafts, initial encounter) is very vague and hard to for me to guess what the reason for the surgery might be based on the code selection.

Without additional information, I'm having a hard time picturing how that could relate to a tympanic membrane repair. Was there a device that malfunctioned and perforated the eardrum?

 

[sls314]

Or did you perhaps mean T85.698A?

(After poking around out of curiosity, I did see some sources use code for retained myringotomy tubes. I'm only speculating, since I'm not sure what the actual reason for surgery was.)