07/21/2022
Healthfirst Denial for 10140-Billed with DX S90.822A
What is the correct ICD 10 code to bill with a 10140? we billed with an S90.822A and it got denied
There are many diagnosis codes per the Medicare LCD policy that are medically necessary for CPT 10140. Per the current coding article (see link below), ICD-10 code S90.822 is not a covered condition. Healthfirst follows the Medicare guidelines for medical necessity for their plans when no specific policy exists for the procedure or item in question. Office notes should be reviewed to determine if a corrected claim should be submitted with one of the diagnosis codes listed in the coding article. If the diagnosis cannot be corrected, notes should still be reviewed to determine if an appeal can be sent to justify the medical necessity of the procedure.