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Diffuse cystic mastopathy

Vijay Posted Tue 18th of December, 2012 17:00:51 PM

Hello,

I am getting denial for Diffuse cystic mastopathy diagnosis 610.1 as age invalid. The patient is 12years old, I wanted to know were can i get the diagnosis list for radiology for such denial to verify with insurance rep if that is a correct or incorrect denial. and also if any one can answer if this denial is correct, if its incorrect what diagnosis code should i bill for Diffuse cystic mastopathy for the age 12years

SuperCoder Answered Wed 19th of December, 2012 00:24:27 AM

You’re likely dealing with a payer age-edit, so you’ll need to check the individual payer.

For example, in the document below, Medicare lists 610.1 as an adult diagnosis for age greater than 14 (see page 24)
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/definition_of_medicare_code_edits.pdf

As far as choosing the final ICD-9 code, compliant coding requires you to code based on what was documented. It’s possible there are other legitimate options based on the documentation, such as other findings.

Vijay Posted Wed 19th of December, 2012 17:40:46 PM

Thanks, I really appreciate your work and help towards me...

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