P Posted Fri 08th of March, 2019 12:24:36 PM
Our doctor's diagnosis for the visit is "left knee effusion, mild osteophyte arthritis, medial meniscus tear, synovitis and pain" Patient has left knee pain for over a year with no injury. We billed 99213 with diagnosis code M22.2x2, M17.12, M25.662, S83.242A. Blue Cross California denied the claim. I was told by their rep that M22.2x2 can not be reported with S83.242A, is this true? I have never heard about it.
SuperCoder Answered Mon 11th of March, 2019 05:22:53 AM
As per coding guidelines, ICD 10 codes from code range (M22.0-M22.3) are exclude 1 codes for ICD 10 CM code S83.242A, which means both codes cannot be billed together. This is as per coding guidelines.
Exclude 1 codes cannot be billed with the code against which it is showing as exclude 1.