Reason Code: 59118

Error Description:

This inpatient 11X claim was denied. The claim contains a valid ICD-10 procedure code for PTA of the carotid artery. However, the claim did not include a valid ICD-10 diagnosis code for PTA of the carotid artery.

Or

One of the valid ICD-10 procedure codes is present and ICD-10 diagnosis codes I672, Z006 and one code from the ICD-10 diagnosis code list for PTA and stenting are not all present on or after the ICD-10 eff date.

Avoiding/Correcting This Error

Review reason code 59118 in the Direct Data Entry system for applicable codes. Alternatively, review the latest Change Requests/MLN^® Matters articles for relevant ICD-10 updates. The most current MLN Matters article is listed in ‘Related Content’ below and includes a link to the most current coding information.

File an appeal if applicable.

Related Content

• CMS National Coverage Determination (NCD) 20.7 Percutaneous Transluminal Angioplasty (PTA)
• CMS Internet-Only Manual 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.7
• CMS MLN Matters article MM13070, ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2023 Update, effective 7/1/2023
  • Note: MM13070 includes a link to a downloadable NCD spreadsheet on ICD-10 and additional coding relevant to select NCDs, including NCD 20.7