Resolved Z23 unacceptable principal diagnosis

[JenniferR_48596]

Cigna is denying our claims with Z23 as principal diadnosis. Patient was not seen for any other reason for the encounter and not a child (over 18). I read the guideline but not sure what to do next. Can you please me some direction on this?

Thanks

 

[Lori]

Z23 is not acceptable as a principal dx.

Use of Z Codes in Any Healthcare Setting Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis.

Z23 is not on the list.

1.21.c.16


Read more on this thread:

Resource - Z Codes

The Importance of Z Codes Z codes, found in Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) of the ICD-10-CM code book, may be used in any healthcare setting. The ICD-10-CM Guidelines for Coding and Reporting instruct us to code for all coexisting...

www.cco.community

Please see this thread on denials as it may be payer specific:

Resource - Denials

Review Reason Codes and Statements CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor...

www.cco.community

 

[MaxJ_73339]

Cigna is denying our claims with Z23 as principal diadnosis. Patient was not seen for any other reason for the encounter and not a child (over 18). I read the guideline but not sure what to do next. Can you please me some direction on this?

Thanks

Claim Denials are the huge issues these days, and it's a hectic process to recheck, finding errors and resubmitting them. My practice has outsourced it's AR recovery to Medcare, we just do normal claims in house.