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DIAGNOIS

Mary Posted Wed 27th of January, 2016 17:02:11 PM

WE SUBMIT CODE 20926 ON MOST OF OUR SURGERIES, BUT IT IS BEING DENIED STATING THAT THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE.
EXAMPLE: 33405,20926 went in with DX: I35.0
EXAMPLE: 35656,20926 went in with DX: I70.212

WHAT DIAGNOSIS SHOULD I BE USING?

SuperCoder Answered Thu 28th of January, 2016 07:59:14 AM

Please check your payer policy and provide the detailed note regarding the diagnosis codes used.

Mary Posted Wed 01st of June, 2016 11:31:14 AM
how do I submit the detailed note regarding diagnosis 20926. sorry I am getting back to you so late. could not remember how to retrieve answer. thank you
SuperCoder Answered Mon 06th of June, 2016 00:47:09 AM
CMS do not provide any applicable ICD-10 against CPT 20926 in their LCD and NCD policies and articles. The ICD-10 CM codes, which you are using against CPT code 20926 looks medically appropriate. But if the payer is denying the CPT code for inappropriate ICD-10 CM code against your CPT code, we would suggest you to ask your insurance carrier/payer for appropriate reason in terms of their medical and coverage policies, which clearly state like what all ICD-10 CM codes are applicable and what all are not against CPT code 20926. Hope this helps!

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