Wiki ZELIS HELP!

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jessieraewinn@yahoo.com

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Hi, so I am getting increasingly frustrated with Zelis coding denials. I keep getting "Procedure not compatible with diagnosis" denials. For example with closure gastrostomy surgery 43870, we are getting a denial for dx code K31.6 (fistula of stomach & duodenum). I have been using these codes together for years. I checked the coding software I use & K31.6 is the number 1 code listed under 43870. Whenever I call Zelis they provide zero help. Does anyone have a document that shows the dx codes that they don't like in relation to specific CPT codes? Or does anyone know how I can get these denials paid and have had luck?

Thank you in advance- rant ended haha

Jessie W, CPC
 
They might be considering that K31.6 would be more appropriate with 43880 than 43870. I assume you have already confirmed that the procedure and diagnosis are both correct? If 43870 is the correct procedure and there is not a more appropriate dx, I would appeal with records. It is hard to say what all they have put in for their edits, but if you have coded properly I would appeal it.
 
jessieraewinn@yahoo.com said:
Hi, so I am getting increasingly frustrated with Zelis coding denials. I keep getting "Procedure not compatible with diagnosis" denials. For example with closure gastrostomy surgery 43870, we are getting a denial for dx code K31.6 (fistula of stomach & duodenum). I have been using these codes together for years. I checked the coding software I use & K31.6 is the number 1 code listed under 43870. Whenever I call Zelis they provide zero help. Does anyone have a document that shows the dx codes that they don't like in relation to specific CPT codes? Or does anyone know how I can get these denials paid and have had luck?

Thank you in advance- rant ended haha

Jessie W, CPC
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Zelis is horrible to get any answer's as to why they do edit's, pricing, etc. Dealing with balance billing with them for the past two years has not been easy or fun. They can't even figure out how to use our claim number in their system so we can cross reference a claims they are inquiring about. Making more work for everyone, but them. Good luck :)
 
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