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Mandy1986:
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 ?


 

Mandy1986:
Insurance Name : Emblem Health


https://www.emblemhealth.com/

Michele:
It is not possible to tell based on the information below.  Have you tried calling Emblem?

Mandy1986:
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.

Michele:
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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