In the January 2014 issue of AAP Pediatric Coding Newsletter™, the official guidelines for reporting conditions that originate in the perinatal period were reviewed. A separate article provided tips and a template letter for appealing claims for care of patients whose condition originated in but continued to require care beyond the perinatal period. There have been continued reports of denied claims for care related to conditions originating within and requiring care beyond the perinatal period with explanation that the reported diagnosis code is not appropriate because of a conflict between the age of the patient and the condition represented by the diagnosis code. In response to these denials, this article is a review of the official guidelines for reporting and a template appeal letter updated to reference International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) guidelines and conventions.

The ICD-10-CM guidelines are described as “a set...

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