02/09/2024

Excellus-Denial for Invalid ICD-10 Codes Reported with 99203, 99212, 99213

We have been receiving quite a few denials from Excellus stating invalid diagnosis codes-denial code M76. The diagnosis are ones that the doctor has used before, and they paid previous claims. An example is that we cannot bill M76.62 with M71.572 or M20.41 with Q66.71. Are they correct?

Denials from Excellus are valid, based on the claim editing guidelines that they are using to process claims. It can reject particular combinations of ICD-10 codes. The recommendation would be to remove one of the diagnosis codes in question and submit a replacement claim for processing. To date, there is no information from Excellus on what code combinations are not allowed based on specialty. These edits have been implemented with other Blue Cross carriers in the region, such as Horizon BC/BS, due to more stringent edits used to adjudicate claims in comparison to other payers like Medicare.