Wiki Insurance denying due to a DX having a note?

[August2]

We are a DMEOP facility and we are billing for a custom AFO. Nebraska Total Care is kicking out the claim stating one of my DX codes has notes located under applicable section headings but will not tell me which DX they are referring to. I looked up all of these codes in my ICD-10 book and cannot see where I made my mistake. Here are a list of my DX and the order I used them too. Any suggestions?

G90.09 Other idiopathic peripheral autonomic neuropathy
M62.81 Muscle Weakness (generalized)
Z89.411 Acquired absence of right great toe
M21.41 Flat foot, right foot
M21.42 Flat foot, left foot

 

[mamurph34]

Not sure if you received an answer to this, but the only code I see with a Note is Z89.411-at the beginning of Chapter 21 the note states in part "Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed." I would start with that to see if that's the problem dx.

 

[thomas7331]

There is an excludes1 note under Z89 that this category excludes codes M20-M21. However, the guidelines state that these may be coded together when the documentation supports that they are unrelated, so the insurance company should deny for this. But rather than fight them on this, I would just eliminate any codes that aren't relevant to the particular item you are billing for. You probably don't really need to include Z89.411 at all as it's eally just informational in this context.