11/30/2018

Correct Coding for Foot Surgery for Screw/Nail Removal-Affinity Health Plan

Our facility submitted a claim with ICD-10 W45.8XXA to insurance company and was denied foe incorrect diagnose code. The patient had surgery on his right foot to remove a screw/nail and Affinity is request we give more specific code for reimbursement.

ICD-10 code W45.8XXA is a valid diagnosis code, but it cannot be billed as the primary diagnosis for the surgery. A corrected claim would need to be submitted to the HMO with another primary diagnosis code that could be supported by the documentation from the op-reports. W45.8XXA can still be reported on the corrected claim as long as it is not the principal diagnosis code.

W codes are meant to be used a secondary:

Most often external cause codes are used in conjunction with codes from Chapter 19 Injury, Poisoning, and Certain other Consequences of External Causes; however, these codes can be used with codes from any chapter to provide additional information on conditions that may be a consequence of an external cause.