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65778 being denied

Marina Posted Tue 15th of October, 2019 16:15:15 PM
I billed procedure code 65778 with ICD 10 code S05.01XD. Blue Cross denied stating "diagnosis does not match the procedure performed". Will you please give me a list of ICD-10 codes that are compatible?
SuperCoder Answered Wed 16th of October, 2019 05:32:54 AM

Hi Marina,

Thank you for your question.

I would like to know the brief history of the patient documented in medical records for which the procedure has been performed before providing you with the list of codes or appropriate diagnosis code that are compatible with CPT code 65778. Also, please mention is it the first visit or subsequent.

Marina Posted Wed 16th of October, 2019 16:29:22 PM
The patient has severe dry eyes including corneal abrasion that was non healing with prior treatment. Subsequent visit
SuperCoder Answered Thu 17th of October, 2019 04:11:20 AM

Hi Marina,

The above-mentioned diagnosis S05.01XD (Injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter), includes injury as well as corneal abrasion of right eye.

However, in your medical documentation, the patient has severe dry eyes including corneal abrasion. That takes us more towards the dry eye syndrome (chronic dry eye that include irritation, redness, and discharge) which may cause corneal abrasion due to irritation.

So, the more appropriate code will be H04.123 (Dry eye syndrome of bilateral lacrimal glands).

Hope it helps.

Marina Posted Thu 17th of October, 2019 12:22:13 PM
Is H04.123 compatible with 65778?
SuperCoder Answered Mon 21st of October, 2019 05:52:37 AM

Hi Marina,

As per CMS codes S05.01XD and H04.123 are not compatible with 65778 instead try the code range mentioned below to match with your medical documentation.

H18.831-H18.839 (Recurrent erosion of cornea, right eye - Recurrent erosion of cornea, unspecified eye).

H18.891-H18.899 (Other specified disorders of cornea, right eye - Other specified disorders of cornea, unspecified eye.

Also, check the given below link to see the code list that can go with CPT 65778.

 

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36237&ver=5&SearchType=Advanced&CoverageSelection=Local&ArticleType=BC|SAD|RTC|Reg&PolicyType=Both&s=All&CptHcpcsCode=65778&kq=true&bc=IAAAACAAAAAA&

 

Feel free to ask for any further query.

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