Denial of Payment due to R62.0 Delayed milestone in childhood
Hi Everyone. I included this diagnosis as dx #10 as the MD notes stated patient who is 67 years old has delayed developmental issues. The reason for denial is because of age-dx mismatch. We use Q codes for cogenital defects like atrial septal defect still present in adults but this is accepted. Any reason why R62.0 code would be considered age inappropriate dx when it is still existing at a later life? Thanks
Comments
Hi there @nkamcodingforum24.
I checked with one of our experts on your question and this is the guidance she provided:
This code is not allowed as primary but that doesn't seem to be the issue. My guess is this is related to a specific payer policy that is blocking the code for the reason stated. While the code is allowed on adult claims if the developmental delay has a current impact on condition, many payers may consider this code questionable. R62.0 is a lesser specified developmental delay- only specifying delayed milestone in childhood such as delay in walking or talking. How this would impact the adult patient's condition is likely more specific to another diagnosis, such as autism (F84.0), Cerebral Palsy (G80.9), or some other condition that is more specific, even if a more specific symptom specifying a speech abnormality or gait abnormality in the adult patient, which is likely what the payer would prefer. While the code set does not prohibit its assignment on the claim for a patient over 18, a payer can implement a policy in which they do not allow specific codes on such claims.
I hope this helps!