[Ohioaap-practicemanagers] Anthem coding edits

[Theresa Vonhoene]

Hi All,


I was just wondering if anyone else had this issue with Anthem claims back in February during flu season where Anthem would not pay the office visit if the claim had both J02.9 (acute pharyngitis) and J11.1 (Influenza).  This was the response we got from our Anthem rep.


I checked in Encoder- and the dx’s that you are having the issue with J02.9 and J11.1 are listed as mutually exclusive and should not be coded together.



Please see below- it is in the section notes on Encoder for the J02 dx range.  You will need to file corrected claims- please keep in mind that this edit is also scheduled to be turned back on in October, so you will begin to see these types of denials again if dx codes that are considered mutually exclusive to each other are coded on the same claim.



 [cid:6717cf4d-42bc-4e87-9206-310dc6154a93]

So Anthem can turn edits on & off so they don't have to pay claims??? Makes no sense to me.


Would love to know if anyone else is dealing with this or did you just correct your claims by dropping off one of the dx codes so the claims would get paid.


Thanks,

Theresa


Theresa Von Hoene, CPEDC
Anderson Hills Pediatrics
Insurance Manager
513.232.8100 x3043



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