Wiki Right Hip Fracture

[chaanobong@gmail.com]

Good morning,
I was wondering if you could help me with this situation.

This diagnosis is denied because it is an external cause.
How will i find a diagnosis for this when the provider only have right hip fracture diagnosis.

 

[kdlberg]

The link/picture you've posted does not work. What is the diagnosis and what is the denial code?

 

[chaanobong@gmail.com]

Sorry about that. The diagnosis is S72.141A displaced intertrochanteric fracture of right femur which is rejected by insurance because of inappropriate primary diagnosis. I try to look up the code it just lost me.

 

[jodielonkoski]

What was the procedure? I tend to see that denial more when they don't think the dx matches with the procedure performed. S72.141A is a valid primary code

 

[chaanobong@gmail.com]

It is just a follow-up, office visit for fall. The provider dx it with right hip fracture

 

[amyjph]

Are you sure that was the only dx on the claim? Did you check to see if there was a external cause code on it which is causing it to reject such as a fall type code? If it is a follow up and no active treatment for the fracture it would not have an A at the end.

 

[amyjph]

Do you have a LT modifier on a RT dx or vice versa?

 

[chaanobong@gmail.com]

Do you have a LT modifier on a RT dx or vice versa?

Are you sure that was the only dx on the claim? Did you check to see if there was a external cause code on it which is causing it to reject such as a fall type code? If it is a follow up and no active treatment for the fracture it would not have an A at the end.

I now removed the A at the end, hope it will work. Thank Amy for the help.

 

[amyjph]

I wasn't saying that was wrong to have, but it has to be a visit for active treatment. I would suggest you take a look at the ICD10 guidelines for fractures. If there is a denial for external cause being coded, it probably has an external cause code on it., If it was a denial for MISSING the external cause being coded for the fracture, you would have to find out what that was and if it is documented (such as a fall or car accident, etc.) you would have to add it.