mblaise1
Guest
Hi~
I have been told by one of our billers that he was told by a rep from Caresource that a particular claim has denied due to a diagnosis (but of course would not give him the exact 2dx in question). I have researched and could only find the following codes (that state needs additional code) which may be the culprit. DOS is 08/12/15 so it is ICD-9.
272.4-Other and unspecified hyperlipidemia (used with CPT 99205-25) - which states use additional code to identify any intellectual disabilities (range 270-279)
599.0 - Urinary tract infection, site not specified (used with CPT 81002) - which states use additional code to identify organism, such as Escherichia coli [E. coli] (041.41-041.19)
I'm rather a novice on medical billing however, my question is: when these messages are stated about using an additional code, is it mandatory (when is it/not)? Would this be the reason for the denial? Evidently, my physician has been using (and still continue to use) the NOS, NEC dx code most of the time but has not been a problem so far.
Thanks in advance for any help/advice given.
I have been told by one of our billers that he was told by a rep from Caresource that a particular claim has denied due to a diagnosis (but of course would not give him the exact 2dx in question). I have researched and could only find the following codes (that state needs additional code) which may be the culprit. DOS is 08/12/15 so it is ICD-9.
272.4-Other and unspecified hyperlipidemia (used with CPT 99205-25) - which states use additional code to identify any intellectual disabilities (range 270-279)
599.0 - Urinary tract infection, site not specified (used with CPT 81002) - which states use additional code to identify organism, such as Escherichia coli [E. coli] (041.41-041.19)
I'm rather a novice on medical billing however, my question is: when these messages are stated about using an additional code, is it mandatory (when is it/not)? Would this be the reason for the denial? Evidently, my physician has been using (and still continue to use) the NOS, NEC dx code most of the time but has not been a problem so far.
Thanks in advance for any help/advice given.