MAR 15, 2022
Claim denials with the diagnosis H35.413 for Lattice Degeneration of Retina, Bilateral
Are you are aware of claim denials with the diagnosis H35.413 for Lattice Degeneration of Retina, Bilateral? We have a high number of denials from a commercial carrier when it is billed with a diagnosis of a retinal hole or tear. Denial reason given is missing, incomplete or invalid diagnosis.
Lattice degeneration can happen prior to the tear or hole. The tear or hole diagnosis is sufficient on the claim for the repair. The reason for denials is that these two ICD-10 codes have an Excludes1 note so they cannot be billed on the same claim.