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Q/A: What’s Wrong with the Diagnoses on my Claim?

By:  Wyn Staheli, Director of Content
Published:  April 22nd, 2019

Question:

I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.

Answer:

Code M79.2 “Neuralgia and neuritis, unspecified” is listed as an “Excludes1” for all M54.1- codes (Neuralgia and neuritis NOS) which means that it can NOT be coded with M54.15 — no exceptions. This is why it is so important to review Includes and Excludes information for diagnosis codes. While cheat sheets are helpful, they don’t generally include this level of information. You need to understand the coding rules and that means reviewing Includes and Excludes (Excludes1 and Excludes2).

Also, don’t forget to review the Excludes for the main categories. For example, M50-M54 has an Excludes1 for “discitis NOS (M46.4-)” so you can’t use any of  the codes in this category with M54.15.

Payers are following these official ICD-10-CM rules when processing claims so you need to make sure you are checking the Tabular List for this very critical information.

The ICD-10-CM Coding for Chiropractic book includes the Tabular List. Also, those with a FindACode.com subscription can see all the Includes and Excludes at the code level — going all the way back to main categories so it’s extremely helpful to make sure you don’t miss anything.

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