"Generic" ICD-10 code denials UMR

edited May 2017 in Orthopedics
Is anyone else having issue with "Generic" code denials from UMR, it seems that any type of "Z" code attached as a diagnosis claims are flagged and not paid and they are insisting on "new corrected claim" and clinical information to be sent. We have attached ICD10 Z09 to dates of service for patients that are s/p surgery BUT are out of the global period with no complications. When I ask for their policy, I am told this is a processors issue. I have even attached Z98.890 too, again told too generic.

Amy Borchardt
Billing Account Specialist
Orthopaedic Associates of Wausau S.C.


  • edited May 2017
    Are you listing it as primary dx?

    Stephanie Schroeder CPC
    500 Vincent Street
    Stevens Point, WI 54481
    T- 715-344-0701 xt 383
    F- 715-344-4494

  • AmyAmy
    edited May 2017
    Yes, I do as Z09 replaced V67.09 with no complications what else would be used?

    Amy Borchardt
    Billing Account Specialist
    Orthopaedic Associates of Wausau S.C.
  • Is there a more specific Z code that could be added after Z09, other than Z98.890? Z09 directs you to add a code from Z86 or Z87. Maybe look at codes under Z87.3, Z87.8, Z87.76, depending on what the original issue was.

    Susan Reinier, CPC
  • Can payors, not have to follow the ICD rules for reporting codes? Do we just report things the way THEY want it for each payor? Today I have a "Request for Additional information" from UMR for billing Z09 and Z96.642 as the patient is in follow up on a TKA with no problems or complications. " The diagnosis code billed is too generic. Please submit a corrected claim/diagnosis code with supporting medical records regarding the following:" They do not like "Z09" as primary code, but per ICD10, you are to report this first when attaching Z86 or Z87 codes. If you send in the records with no change to Dx codes, they still deny for "generic coding". I was told that this will require a phone call EVERY time if the Dx codes are not "corrected", as their system kicks out the Z09 as too generic.
  • Wow I was starting to think I was the only one-we also are having the same problem the patients coming back in for a 1 year follow up after a total hip or knee and we use the Z codes as well Z96.641 or Z96.651 and I too was putting the other Z code as the primary code Z47.1 but it does not matter they deny them for "invalid/missing diagnosis code" please resubmit with a more appropriate code. I DO NOT HAVE ONE...so frustrating since this is the only payor not accepting these codes. I did reach out on their website and was told they did if Medicare is primary these claims should not deny and they believe this has been corrected as this was an issue since they did an update in 2017. I replied back asking for answers on the patients who do not have Medicare as their primary. I have not received a response back yet. I looked all over the website for a policy guideline showing these codes to be invalid and could not find one. If anyone has gotten any more information on this matter would be so greatful.

    Stacey M.
    Medical Billing
    GIKK Orthopedics
  • We are having this same issue with UHC when we use any of the Z aftercare codes when patient is in a global. Unfortunately, when it comes to coding; insurance companies can make up their own rules/policies and we are at their mercy.
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