I code for 6 Pediatricians. BCBS is denying diagnosis P59.9 (Neonatal jaundice) as an unspecified code. We have always used this code without any problems. Is anyone else having this issue, and what code are you using.
There are several things to look at and they are correct this is an unspecified code, which I'm sure you are aware.
Review the policy to see if BC changed their policy and have exclusions for this diagnosis, especially if they processed your claims in the past, Either way, I suggest viewing the payer's policy to determine if the policy changed or you may be looking at a compliance issue, if they should not have been paying and just caught the edit.
* Are you reporting P59.9 as a "Well" baby or "sick" baby? Some payers will only accept this unspecified code used for a "Well" baby.
* Are the babies getting treatment? If so then the CPT code will also play a part, are you billing for normal newborn care or something else?
* Are there missing Modifiers?
* Is there another diagnosis code you are using with this code?
* Is there a more specific code that is applicable to further specify the condition such as, P59.8 - Neonatal jaundice from other specified causes or associated with preterm delivery P59.0 or due to something else?