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MAJOR POINT OR BURSA ( EG. SHOULDER, HIP, KNEE JOINT)

Shade Posted Wed 29th of October, 2014 11:50:49 AM

PT. WAS SEEN FOR A HIP PAIN AND THE MAJOR POINT INJECTION WAS DONE. WE CODED ITH 20610 WITH DX. CODE 719.45 AND THE CLAIM WAS REJECTED BY INSURANCE CLAIMING THAT DX CODE IS NOT RIGHT. WOULD DX CODE 715.95 MORE APPROPRIATE. PLS HELP ASAP. THANK YOU.

SuperCoder Answered Wed 29th of October, 2014 12:53:53 PM

Thanks for your question. Although both codes are appearing as a covered diagnosis code to use in conjunction with 20610. 719.45; Pain in joint involving pelvic region and thigh is the appropriate code for hip pain. If your provider does not document osteoarthrois you should not use diagnosis code 715.95. Is there a particular insurance company that you are receiving a denial from?

Shade Posted Wed 29th of October, 2014 14:02:23 PM

HUMANA INSURANCE. I WAS SURPRISED AND CONFUSED TOO BECAUSE THE DX CODE 719.45 SEEMS TO BE PERFECT FOR THE PROCEDURE CODE. 715.95 WAS DOCUMENTED AS A DIFFERENTIAL CODE. WHAT SHOULD I DO. PLEASE HELP. PLS ANSWER IS NEEDED ASAP.THANK YOU.

SuperCoder Answered Thu 30th of October, 2014 00:24:50 AM

It is unusual that this diagnosis is not covered by the insurance company. I would advise you to call Humana and have them provide you with an explanation as to why this diagnosis is inappropriate. You may need to appeal this claim denial.

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