Wiki DX code R68.12

[mra1110]

Hello! I just need some clarification on ICD 10 code R68.12. Is there an age range for this code? One of our Ohio Medicaid HMO providers keeps denying this claim stating it cannot be used for patients over 11 months. Our patient was 18 months when seen in our ER. I cannot find anything with an age restriction on this. Can anyone assist?

 

[AmandaBriggs]

Infancy typically only applies to the first year of life, so up to 11 months 364 days. I would bet that your Medicaid HMO has some rules or definitions of this.

 

[trarut]

The code description is specifically for a "fussy infant (baby)" so I'd say that's why it can't be used for your patient.