Wiki Please help answer a dispute.

[amomma10]

Me and a co-worker of mine have disputed with each other and the billing office about the code for Mycoplasma Pneumonia. I feel that it should be coded J157 and she says B960. The billing office is saying that code B960 is not being accepted. The coding guidlines state that the underlying disease should be sequenced first. Can anyone help please.

 

[CodingKing]

According to the CDC, M. pneumoniae doesn't always cause Pneumonia. It can cause other infections or even something as simple as a chest cold. So if the patient has pneumonia caused by M. pneumonia the J code is correct

J15.7 - Pneumonia due to Mycoplasma pneumoniae

http://www.cdc.gov/pneumonia/atypical/mycoplasma/about/signs-symptoms.html

 

[thomas7331]

You would not code the B96.0 in addition because J15.7 is already a combination code that includes the information about the organism. Per the ICD-10 guidelines "Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code." So I think the reject that your billing office is getting is correct that this is not a valid code combination.

 

[mitchellde]

B96.0 is a secondary only allowed code. If you look in the code book the instructions for that section state this. You would need a code for the condition caused by the mycoplasma pneumonia. I agree the J15.7 is the only code you need for the stated scenario.