Take a FREE Trial TODAY. Signs and symptoms coding is the key until you have a definitive diagnosis Too often, carriers refuse a polycystic ovarian syndrome (PCOS) diagnosis because it indicates infertility, and they don't pay for infertility treatments. But you can get paid for treating suspected PCOS because the patient usually has other symptoms.
PCOS isn't simply a fertility problem. Unfortunately, many insurance carriers either don't understand that fact or choose to ignore it.
The problem often arises when an insurance carrier receives a claim listing only a PCOS diagnosis. If the patient has received diagnostic testing or treatment for suspected PCOS, the carrier assumes that the patient is receiving fertility treatment and automatically issues a denial. So by coding the patient's condition as 256.4 (Polycystic ovaries) before you have a definitive diagnosis, you've fallen into a coding trap and effectively denied your practice reimbursement for services rendered to that particular patient. Code the Chief Complaint First If you don't report the initial diagnosis as PCOS, how should you code it? The key is to code the chief complaint. A patient generally doesn't walk into your office and say, I have PCOS. A patient usually walks in and says "I haven't had a period in four months. What's wrong with me?" In that case look to the codes for irregular menses (626.4) or hypomenorrhea (626.1) or other disorders of menstruation (626.8).
PCOS isn't always easily diagnosed and coding the complaints provides certainty. If there's any question whether the patient has PCOS you should code the secondary characteristics.
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