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Chiropractic Coding & Compliance Alert

Reader Question:

Here's Why Some Payers Are Denying M99.01

Question: Why is my claim with diagnosis M99.01 being denied?

California Subscriber

Answer: Neither the codeset nor the LCDs are perfect, meaning there is always room for improvement. One such case is the Noridian Chiropractic Services (LCD) L34242, reported on Oct. 14, 2015. It applies to Part B JE Claims from California, Hawaii, Nevada, American Samoa, Guam, and Northern Mariana Islands. Practitioners are reporting that their claims are being denied when billed with a payable primary diagnosis code of M99.01, M99.02, M99.03, M99.04, and M99.05.

Action taken: The LCD is being updated to contain the appropriate diagnosis codes. Once complete, Noridian will identify the claims denied incorrectly and adjust them.