When drafting any appeal letter, always check to ensure it includes all of the following elements:

As an example of using a reference to support your coding, appeal of a claim denial due to diagnosis codes based on inappropriate addition of age edits for perinatal codes/congenital codes should include very specific references from the ICD-10-CM manual about how these codes are indeed appropriate beyond the first 28 days after birth. Included in that reference should also be the adherence to ICD-10-CM guidelines as part of the Health Insurance Portability and Accountability Act and any direct violations that can be reported.

Visit Coding Resources on this site for a letter template for appealing a claim denied due to diagnosis code/age edits.

You do not currently have access to this content.