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Diagnosis inconsistent non payment remark

Mary Posted Sat 21st of June, 2014 15:50:42 PM

We are coding 17110 with 078.10 and just in the past two months, both Tricare and BC/BS have denied payment indicating diagnosis is inconsistent with procedure? I have researched both CPT and DX and can find no updates or edits?? Is there anything I have missed or should we appeal our claims?
Thanks.

SuperCoder Answered Mon 23rd of June, 2014 07:34:58 AM

SuperCoder Answered Mon 23rd of June, 2014 07:48:32 AM

Thanks for your question.

You should appeal your claims with supporting documentation that justify the medical necessity. "Diagnosis is inconsistent with procedure" doesn't seems to be a valid denial. Thanks !!

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