Your guide to incidental and mutually exclusive conditions. Learn which diagnosis codes cannot be billed together
Claim denials are always frustrating. A large portion of underpayments occurs because of improper claim processing by insurance payers. However, in some cases, denials may as a result of a provider being non-compliant with a payer’s coding policy, or even with the one established by the CMS. Namely, some plans determine the health conditions that cannot be reported simultaneously.
Let us take a look at the most common diagnosis codes that cannot be billed on the same claim:
1) M79.604 (Pain in right leg), M25.551 (Pain in right hip), M25.561 (Pain in right knee), M25.562 (Pain in left knee).
2) M25.562 (Pain in left knee), M79.661 (Pain in right lower leg), M79.662 (Pain in left lower leg)
These conditions are considered to be incidental to each other by the CMS, and their combinations are non-reimbursable.
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