I’m just wondering if anyone else is receiving denials from UMR on their follow up visits after surgeries. It’s our E&M’s (after the global period of course) and x-rays that are getting denied and it’s random. Not all of them are denying, just ones here and there.

With our spine fusions and other general orthopedic surgeries (i.e. bunionectomies, meniscectomies, epicondylectomies, etc), we’ve been using Z47.89. I do not see a code that specifically states "encounter for surgical aftercare for musculoskeletal". I see orthopedic NEC which directs me to Z47.89.

UMR is denying these charges stating the diagnosis is not coded to the highest level of specificity and they are denying our appeals when I send them copies of the aftercare section showing that ICD 10 refers us to Z47.89.

UMR reps are stating that they have increased their scrutiny of ICD 10 codes and require specificity but unless I’m missing something, I don’t see how we can code these general procedures any more specifically.

I’m planning to contact them to see if a certified coder or someone responsible for ICD 10 implementation at their organization can review our denials but was wanting to reach out to the coding community to see if anyone else has run into this or done anything with success and can share some advice with me.

Thank you!

Kimberly