Forum - Questions & Answers

Apr 28th, 2015 - kkbloom 3 

Denial from insurance stating that diagnosis code 238.2 is inconsistent with the procedure.

Trying to figure out why I got a denial for this:
CPT® code 11421 was billed with diagnosis code 238.2 and the insurance denied payment stating the diagnosis is inconsistent with the procedure. On the same claim the procedure code 12041 was also billed with diagnosis code 238.2 and we were paid. Can anyone help me with this?

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Apr 29th, 2015 - LBAROGIANIS 250 

re: Denial from insurance stating that diagnosis code 238.2 is inconsistent with the procedure.

Code 11421 is a removal of like a mole or something and CPT® 12041 is complex suture repair.. Did you do both? Skin would match up to 12041 and you would need something better as to what you are removing with 11421.

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Apr 29th, 2015 - petunia 195 

re: Denial from insurance stating that diagnosis code 238.2 is inconsistent with the procedure.

I would appeal to the carrier with notes. 238.2 is consistent with 11421 and 12041 is an appropriate intermediate closure code to bill with 11421.

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