Wiki Denied to "dx is inconsistent with procedure"

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minoweka

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Patient is MediCal (Medicaid-California) with pregnancy/post partum related eligibility only.

We have billed 99212 / 646.63.

MediCal is denying to "dx inconsistent with procedure".

The dx is ante-partum related. I can not determine what else MediCal is looking for. Any ideas?

Thank you.
 
Hi Debra,

Thank you for your response.

We did perform UA with 599.0, was paid. However, we did not bill the E&M with both dx (646.63/599.0)

I will bill 99212 with both dx.

Thank you so much.
 
Ah that is the problem.. technically you do not bill these 2 together as that is redundant so the culture should have been the 646.63 also that is why it is inconsistent, you have a culture saying not pregnant and a visit saying pregnant. the additional dx code the 646.63 is looking for is the culture result.
 
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