Medical Billing Forum
Billing => Facility Billing => : Mandy1986 August 22, 2019, 01:01:35 PM
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Hi
i have discus something about a billing part for a patient currently with us. we are getting denial for her claim as DIAGNOSIS WAS OMITTED OR INCONSISTENT WITH PROCEDURE/REVENUE CODE
DX used for billing :DX1: F31.13, DX2: F43.10, F12.20
Revenue Code: 913
CPT :H0035
PHP-MH
Bill type:131
Can someone assist me ?
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Insurance Name : Emblem Health
https://www.emblemhealth.com/
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It is not possible to tell based on the information below. Have you tried calling Emblem?
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Yes, They told per there coder DX codes :F31.13, F43.10, F12.20 not support Revenue Code: 913 CPT :H0035, Bill type :131
it is hospital billing Mental health treatment center.
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The dx codes are valid, the rev code is valid, and the type of bill is valid. There must be something about this specific plan that does not cover partial hospitalization for those codes.
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Emblem will only accept Rev 912. Hope that gets you paid!
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thank you Nick D. Yes, It worked :)
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Awesome 8)