Author Topic: Principal Procedure Code Denial  (Read 2191 times)

adaniels5244

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Principal Procedure Code Denial
« on: October 05, 2015, 04:52:38 PM »
Is anyone getting denials for Detox billing ICD-10 codes but not liking the Principal Procedure Code?

Michele

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Re: Principal Procedure Code Denial
« Reply #1 on: October 06, 2015, 05:57:29 AM »
So are you saying they are denying based on the CPT code, not the ICD code?
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adaniels5244

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Re: Principal Procedure Code Denial
« Reply #2 on: October 06, 2015, 03:11:48 PM »
They are denying our Principal Procedure Code in Box 74 of the UB-04 of 94.62.  We only use these codes when billing Detox level of care.  I'm not aware if these changed with the new ICD-10 or not.  A 94.62 is a Principal Procedure Code of Alcohol Detox Only.

rdmoore2003

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Re: Principal Procedure Code Denial
« Reply #3 on: October 06, 2015, 04:44:06 PM »
that looks like a diagnosis code and not a cpt code.
Regina

adaniels5244

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Re: Principal Procedure Code Denial
« Reply #4 on: October 06, 2015, 05:02:22 PM »
We are billing with a diagnosis of F13.20, Revenue Code 0126 Inpatient Detox, CPT Code H0010.  In Box 74 we are putting the Principal Procedure Code of 94.65.  My guess is those changed for the new ICD-10, but can't find to what Principal Procedure Code would go with a diagnosis F13.20.

kristin

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Re: Principal Procedure Code Denial
« Reply #5 on: October 06, 2015, 07:00:11 PM »
When I look up 94.65, that comes up as a ICD-9 code, and NOT a CPT procedure code.

Only diagnosis codes changed with ICD-10, not CPT procedure codes.

RichardP

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Re: Principal Procedure Code Denial
« Reply #6 on: October 06, 2015, 07:24:14 PM »
Only diagnosis codes changed with ICD-10, not CPT procedure codes.

I'm speaking out of ignorance here, since we don't do hospital billing.  The document at the link below begins with this first sentence:

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.

I've seen this statement in various forms over that past few months as I have been reading and switching the diagnosis codes over to ICD-10.  We have clients who see patients in the hospital, both as in-patient and out-patient.  So I was/am interested in making certain I understand which CPT codes are changing to ICD-10 and which are not.

Somewhere in my reading (can't put my hand on it at the moment) I saw that ICD-10 CPT codes applied only to institutional inpatient billing.  The inpatient CPT codes for providers seeing patients in the hospital/institution are not changing, but the inpatient CPT codes used by the hospital / institution are.

The OP makes mention of the UB-04 form, which is institutional, which makes me think maybe their CPT Codes have changed.  But, again, I'm speaking out of ignorance here.

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introduction20140819.pdf

Michele

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Re: Principal Procedure Code Denial
« Reply #7 on: October 09, 2015, 08:59:10 AM »
94.65 is definitely from the ICD9 set.  Is box 74 required for detox?  I didn't think that was one of the required fields.
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