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Accident

Marilyn Posted Sun 15th of December, 2013 12:02:17 PM

When a patient is seen for MVA with additional dx as in HTN, HA, OM, do I bill all to car ins or to regular medical insurance?

SuperCoder Answered Mon 16th of December, 2013 08:56:23 AM

Hi,

We are working on this.

Thanks,

SuperCoder Answered Wed 18th of December, 2013 13:25:20 PM

Car insurance only receives the diagnoses the patient received as a result of the MVA.

Marilyn Posted Fri 27th of December, 2013 09:30:34 AM

So, bill car insurance for MVA diagnosis and the non MVA diagnosis to patients regular medical insurance?

SuperCoder Answered Thu 09th of January, 2014 16:15:51 PM

Just because the patient has non-accident related diagnoses, i.e. hypertension, doesn't mean that there was a billable service to the patient's private health insurance. The following is an excerpt from the ICD-9-CM Official Guidelines for Coding and Billing: (bold emphasis added)
Section IV
K. Code all documented conditions that coexist
Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist. However, history codes (V10-V19) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.
If the patient's diagnoses have an affect on the patient's treatment of the auto-injury condition(s), then it would be compliant to additionally report those ICD-9 codes. However, if the patient's non-accident related diagnoses do not require and/or affect the patient's auto-injury related care, then it would not be compliant to additionally report these ICD-9 codes.

In some states, the patient's health insurance should be billed for auto-related injury services. Whereas in other states, often with no-fault auto coverage, the patient's injuries are billed to the Personal Injury Protection (PIP) insurance carrier.

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