chisomnwaneri
Guest
Hi Please, could anyone give me a hint why I keep getting denial on office visits with invalid/incomplete diagnosis reason and my diagnosis are 1st diag: R11.11, 2nd diag: R19.7, and 3rd: R21. Could it be the arrangement
I don't see where R21 needs a 4th digit. That's been the code for rash NOS since ICD10 started and is still valid in my 2023 book.Hi Chisomnwaneri
All these are unspecified dx codes and dx R21 needs 4 digits. Is your provider not giving you a exact definitive dx ? If not you have to use the symptoms R block dx codes. Also keep in mind most dx codes a have another medical term in section of ICD10 manual that deals with differ specialty. You know gastro health is in section of disease manual starts with K. Instead of R19.7 you could use dx K59.1, or K58.O but the provider needs to give you detailed diagnosis codes in his or her documentation to match these dx. You should not have to guess. However if the medical record says these R codes......you cannot change the claim now. Dx R19.7 and R11.11 are unspecified some payers do not want to reimburse for this they feel a more definitive dx should be used. Is a better diagnosis listed in medical documentation ? Again if provider does not document a detailed dx code ; you are stuck using unspec. dx codes. Payers denial be the provider s fault. Keep in mind the inpt. setting can use R codes. Outpatient setting the payers do not like use of unspecified dx codes, however sometimes must be used.
Well I hope helped you a tiny bit.
Lady T