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dtamayo

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Hello I am currently working on edits and denials and keep getting a invalid dx denial when M12.812 and M19.212 is on same claim however my coding software does not show anything wrong with these two being coded. Does anyone have any info on these two dx codes .
 
Hi Dtamayo
Per the payer this is describing the same thing...type of Arthritis and it is consider redundant (joint pain and arthritis). M12.812 and M19.212 both arthritis of left shoulder. I know there is no Excludes Rule 1 with these 2 diagnosis but not given enough info. Also when the 2nd dx arthritis is chosen this is due to some other underlying condition ...does the patient have a reason per the documentation .Did the provider note this?

What is the difference between arthritis and arthropathy?
An arthropathy is any disease affecting a joint. An arthropathy can affect a single joint (monoarticular arthropathy or monoarthropathy) or many joints (polyarticular arthropathy or polyarthropathy). Arthritis is defined as any condition causing inflammation within a joint.

What is the best definition of osteoarthritis?
Osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time. It is the most common type of arthritis and is more common in older people. People with osteoarthritis usually have joint pain and, after rest or inactivity, stiffness for a short period of time.

Well hope explained reason I think payer rejected it
Have a good day
Lady T
 
You're trying to code a specific diagnosis and an "other specified" in the same shoulder. What did the medical record documentation state is the diagnosis. Refer to your ICD-10 coding official guidelines.
 
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