NOV 13, 2022
Coding Coach Versus Payer Policy
We use Coding Coach to confirm that diagnosis codes support CPT codes utilized by our providers. Recently we billed CPT 92133 with ICD-10 H47.213. The claim was denied because the diagnosis did not support the CPT per National Government Services (NGS) article A56537. Is one of these resources wrong?
Although H47.213 is a covered diagnosis for other Medicare administrative contractors, it is not for NGS. The No. 1 question in medical coding is, “Who is the payer?”
The preface to the Coding Coach teaches “… because coding changes may vary by payer and also are updated frequently, you should still consult your local payer website and pay particular attention to their local coverage determinations (LCD) policies. The Academy also has a dedicated page for practices to view current policies. Visit aao.org/lcds
for additional information.”
It is a good idea to make notes in the Coding Coach about your top payer guidelines.