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cpt 99213 denied due to one ICD denying off another ICD

Fion Posted Thu 11th of February, 2016 11:57:00 AM

I have a denied claim from the wellcare, the denied reason cpt 99213 denied due to one ICD denying off another ICD.

Patient is 72 year's old, female, the claim was submitted with the following dx
1. Functional dyspepsia - K30 (Primary)
2. Dorsalgia, unspecified - M54.9
3. Age-related osteoporosis without current pathological fracture - M81.0
4. Pure hypercholesterolemia - E78.0
5. Impaired fasting glucose - R73.01

Can you help me look into the problem, I really don't know which icd is denying off another icd. Please help me out!

SuperCoder Answered Fri 12th of February, 2016 08:15:16 AM


The ICD code selection seems appropriate. I don't think there should be any clash. However, You can try to bill with K30, E78.0, R73.01 without M81.0 and M54.9.

Also, check your payer policy for any specific guidelines related to billing.


Fion Posted Wed 17th of February, 2016 12:12:14 PM

Thank you very much for your help!

SuperCoder Answered Wed 17th of February, 2016 23:46:43 PM

Happy to Help!

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