Re Malignant pleural effusion

cmercier@vnhsc.orgcmercier@vnhsc.org
in Home Care Coding General
According to Decision Health ICD-10 does NOT consider Malignant pleural effusion (J91.0) to be a manifestation code, however, when our billing dept sent out the RAP with Malignant pleural effusion (J91.0) as primary dx, it was denied.

In addition, according to Decision Health Monthly Magazine November 2016 issue it stated that if the Cancer site is unknown that you could use J91.0 as primary.

Can someone help please!!
Thank you!

Comments

  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited May 2017
    J91.0 Malignant Pleural Effusion states to CODE FIRST UNDERLYING NEOPLASM
    You cannot use J91.0 as primary

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
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