Author Topic: 99204 Help  (Read 1536 times)


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99204 Help
« on: March 22, 2010, 01:24:53 PM »
We do paper claims for a physician. He has a new patient that he added to is patient list. The first claim he had for this new patient, he use the procedure code 99204. And for the ICD9 code he used 242.9(hyperthyroid). Can this ICD9 code be used with 99204? Or are there only certian IDC9 codes that can be used for CPT code 99204?

The claim was denied by Medicare:
CO       Contractual Obligation. Amount for which the provider is financially liable. The patient may not be liable for this amount
11       The diagnosis is inconsistent with the procedure.
MA130  Your claim contains incomplete and/or invalid information. and no appeal rights are afforded because the claim is unprocessable.
M81      You are required to code to the highest level of specificity.


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Re: 99204 Help
« Reply #1 on: March 22, 2010, 04:24:06 PM »
The diagnosis 242.9 requires a 5th digit. Either 0 (without mention of thyrotoxic crisis) or 1 (with mention of thyrotoxic crisis)  the doctor needs to tell you which one it is.  Just correcting the diagnosis may be enough.

This diagnosis alone may not be enough to warrant a 99204.  The guidelines for what constitutes a 99204 are that it must be a comprehensive history, a comprehensive examination, and decision making of moderate complexity. 

You may also want to check the LCD's for your area.  Medicare has some pretty specific guidelines for diagnosis.