Sequela Codes & Unspecified ICD-10 Billing Issues
Melissa Edwards
Description
Collection
Title:
Sequela Codes & Unspecified ICD-10 Billing Issues
Creator:
Melissa Edwards
Date:
5/22/2019
Text:
We have had numerous issues more and more frequently with Medicare and Commercial insurances not accepting sequela codes and diagnoses with either unspecified in the Category or Extension. Specifically with the Section and Body Part.
We have now had a Medicaid replacement (Aetna Better Health) state we cannot use ICD-10's that begin with the letter S.
Examples:
S82.892S- Other fracture of left lower leg, sequela
S82.832A- Other fracture of upper and lower end of left fibula, initial encounter for closed fracture
G80.9- Cerebral Palsy, unspecified
R62.50- Unspecified lack of expected normal physiological development in childhood (we will typically get this when a pediatric patient has not yet been officially diagnosed so the physician only has this diagnosis at the time we are treating the child).
Also, we have many diagnoses coming from physicians with sequela codes and the insurance claims department is denying the claim stating it cannot be a sequela code or rejecting the claim entirely.
Has anyone else had or is having a similar issue and what have you been able to uncover? I have reached out to our Medicare liaison as well and am waiting for their response from the as well that I can pass along.
Melissa Edwards
Business Operations Manager
[New Logo- VP&O B&W]
4338 Williamson Rd. NW
Roanoke, VA 24012
P:(540) 366-8287
F: (540) 767-0010
<Email Address Redacted>
THE DOCUMENTS ACCOMPANYING THIS TRANSMISSION CONTAIN CONFIDENTIAL HEALTH INFORMATION THAT IS LEGALLY PRIVILEGED. THIS INFORMATION IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY NAMED ABOVE. THE AUTHORIZED RECEIPIENT OF THIS INFORMATION IS PROHIBITED FROM DISCLOSING THIS INFORMATION TO ANY OTHER PARTY UNLESS REQUIRED TO DO SO BY LAW OR REGULATION AND IS REQUIRED TO DESTROY THE INFORMATION AFTER ITS STATED NEED HAS BEEN FULFILLED.
IF YOU ARE NOT THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISCLOSURE, COPYING DISTRIBUTION, OR ACTION TAKEN IN RELIANCE ON THE CONTENTS OF THESE DOCUMENTS IS STRICTLY PROHIBITED. IF YOU RECEIVED THIS INFORMATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY AND ARRANGE FOR THE RETURN OR DESTRUCTION OF THESE DOCUMENTS.
We have now had a Medicaid replacement (Aetna Better Health) state we cannot use ICD-10's that begin with the letter S.
Examples:
S82.892S- Other fracture of left lower leg, sequela
S82.832A- Other fracture of upper and lower end of left fibula, initial encounter for closed fracture
G80.9- Cerebral Palsy, unspecified
R62.50- Unspecified lack of expected normal physiological development in childhood (we will typically get this when a pediatric patient has not yet been officially diagnosed so the physician only has this diagnosis at the time we are treating the child).
Also, we have many diagnoses coming from physicians with sequela codes and the insurance claims department is denying the claim stating it cannot be a sequela code or rejecting the claim entirely.
Has anyone else had or is having a similar issue and what have you been able to uncover? I have reached out to our Medicare liaison as well and am waiting for their response from the as well that I can pass along.
Melissa Edwards
Business Operations Manager
[New Logo- VP&O B&W]
4338 Williamson Rd. NW
Roanoke, VA 24012
P:(540) 366-8287
F: (540) 767-0010
<Email Address Redacted>
THE DOCUMENTS ACCOMPANYING THIS TRANSMISSION CONTAIN CONFIDENTIAL HEALTH INFORMATION THAT IS LEGALLY PRIVILEGED. THIS INFORMATION IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY NAMED ABOVE. THE AUTHORIZED RECEIPIENT OF THIS INFORMATION IS PROHIBITED FROM DISCLOSING THIS INFORMATION TO ANY OTHER PARTY UNLESS REQUIRED TO DO SO BY LAW OR REGULATION AND IS REQUIRED TO DESTROY THE INFORMATION AFTER ITS STATED NEED HAS BEEN FULFILLED.
IF YOU ARE NOT THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISCLOSURE, COPYING DISTRIBUTION, OR ACTION TAKEN IN RELIANCE ON THE CONTENTS OF THESE DOCUMENTS IS STRICTLY PROHIBITED. IF YOU RECEIVED THIS INFORMATION IN ERROR, PLEASE NOTIFY THE SENDER IMMEDIATELY AND ARRANGE FOR THE RETURN OR DESTRUCTION OF THESE DOCUMENTS.
Citation
Melissa Edwards, “Sequela Codes & Unspecified ICD-10 Billing Issues,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 24, 2024, https://library.drfop.org/items/show/209609.
