Questions: A billing and coding specialist is reviewing a remittance advice and encounters a denial of payment for CPT code 44950 (appendectomy). The specialist discovers the ICD-10-CM code assigned to the claim was J32.1 (chronic frontal sinusitis). Which of the following is the reason for this claim denial? Incorrectly linked codes were reported on the claim A lower level of care could have been provided Bundled service Pre-existing condition

The answer is the first one: Incorrectly linked codes were reported on the claim.

Explanation for each option:

1. Incorrectly linked codes were reported on the claim: This is the correct reason for the claim denial. The CPT® code 44950 is for an appendectomy, which is a surgical procedure to remove the appendix. The ICD-10-CM code J32.1 is for chronic frontal sinusitis, a condition related to the sinuses. These codes are not related to each other, as an appendectomy is not a treatment for sinusitis. Therefore, the claim was denied because the procedure code and diagnosis code do not match appropriately.

2. A lower level of care could have been provided: This option is incorrect because it refers to situations where a less intensive or less costly treatment could have been used. It does not apply here, as the issue is with the mismatch of procedure and diagnosis codes.

3. Bundled service: This option is incorrect because it refers to situations where multiple services are included under a single payment. The denial in this case is not due to bundling but due to incorrect code linkage.

4. Pre-existing condition: This option is incorrect because it refers to conditions that existed before the patient received insurance coverage. The denial here is not related to a pre-existing condition but to the incorrect linkage of procedure and diagnosis codes.

In summary, the claim was denied because the procedure code for an appendectomy was incorrectly linked to a diagnosis code for chronic frontal sinusitis, which are unrelated.