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Primary DX needed for 616.10

Charles Posted Wed 29th of October, 2014 22:33:53 PM

We frequently receive denials when 616.10 is listed as the primary DX however my providers do not feel there is another diagnosis that would be appropriate as primary. They state that pinworm vaginitis is not correct and cannot be used. What DX would work in these sistuations? It's a normal office visit 99213 with 616.10 DX.

SuperCoder Answered Thu 30th of October, 2014 08:06:20 AM

Thanks for your question. There should not be a reason why this code is unacceptable as a primary diagnosis. There are no guidelines for this code stating that it cannot be used as a primary diagnosis. This may be an issue with a particular payer. You should definitely contact your payer to get further explanation as to why they would not cover this code for an established office visit. If your provider documents bacterial or just vaginitis and does not specify further, then 616.10 would be the appropriate code. I agree if the patient does not have pinworm vaginitis then that diagnosis should not be coded. Does your documentation indicate if there is a cause for the vaginitis (ex. candida, C. albicans, etc)?

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