Author Topic: # of Spinal Regions not Correlate (98941)  (Read 2291 times)

dfranklin

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# of Spinal Regions not Correlate (98941)
« on: February 17, 2010, 01:32:25 PM »
I get this code a lot with many different carriers (mostly commercial/auto like State Farm, Kemper etc):

# of spinal/body regions does not correlate to the # of regions as described in the procedure code(s). Supporting documentation is required.


So it seems I am always having to send chart notes. Is there something else I can do to avoid this?  Should I be reporting the DX codes differently?  You only have room for 4 so I am always putting the 1st 4 provided by the doctor unless he says for today only use 739.6 and/or 739.7 for 98943 then I add those.

For example I used Dx  839.20, 724.2, 839.05, 723.1

and CPT 98941, 97140, 98943-51 billed to Kemper Auto Home Ins.

and I received the above error for 98941.

Any suggestions or is it just the fact that I will typically have to send notes with many of these for 98941?

Thanks!

DMK

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Re: # of Spinal Regions not Correlate (98941)
« Reply #1 on: February 17, 2010, 04:23:01 PM »
I think we talked about this before.  You MUST have three areas of injury as your first three dx's in order to get a 98941 (Adjust 3-4 areas) paid.   With what you showed, you should have a neck code, mid back code, and a low back code, (either a 839.XX subluxation code or 739.X intersegmental dysfunction code) AND an extremity code (for a 98943).  The lumbago code and the cervicalgia code can be tacked on the end, they don't need to be in the first four.

Re-ordering the dx's should solve the error message.

If it's a car accident, you may need to send notes with each bill anyway, they sometimes request that.

Hope that helps!

Dina

Michele

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Re: # of Spinal Regions not Correlate (98941)
« Reply #2 on: February 18, 2010, 08:15:02 AM »
We run into the same problem.  Sometimes we actually hand write additional diagnoses codes on the claim, and we usually attach the notes.  Sometimes it works, sometimes it doesn't.  We just appeal when they deny.

Michele
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dfranklin

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Re: # of Spinal Regions not Correlate (98941)
« Reply #3 on: February 18, 2010, 01:31:36 PM »
I guess this is where I run into a problem because I don't know the codes...you say I should have a neck, mid back and low back code ( I am assuming for the 98941 becuase it is for 3 areas) but I am not sure what codes are for those areas...I guess this is where we do need to know some coding and I am lacking knowledge on.  Is there somewhere to learn what we need about codes for a biller and not full blown coding as I don't think we need to know everything a coder does or do we?  I am sure a lot of my issues are around the DX's and the orders etc but I don't know enough to know how it should be.

For 98943 he typically writes 739.6 or 739.7 next to it on the superbill and says for this visit only (he didn't in this case so I am not sure what would be his extremity code for the 98943 here) and I put it into the #4 DX position.

And is re-ordering the DX's something I should or can be doing? Or should I be telling the provider he needs to put them in the proper order?

Thanks for your help! I don't know where i would be without this site and you guys that help us out!!! Thanks!

DMK

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Re: # of Spinal Regions not Correlate (98941)
« Reply #4 on: February 19, 2010, 11:22:36 AM »
You make a great point, since I work right next to the Doctor I can always ask him right away!  The Doctor should understand coding, and how it relates to him or her getting paid.  H J Ross puts on great seminars that are good for the billers and the Doctors.  It's a good way to cross check. 

The Doctor should understand Medicare coding especially!  The 2nd diagnosis, or complicating factor will actually determine how much treatment he will get paid for.

I hope this is helpful!

Dina