Jan Posted Wed 10th of March, 2010 14:13:09 PM
We sent a 6 wk old baby that was breeched at birth, over to the hospital for an ultrasound of the hip and coded it with 652.20. The films were normal and the radiologist coded it with V82.3. Dad called us and his insurance is not going to pay for the V82.3. The insurance coder at the hospital states that they can't use the 652.20 because it's a mama code. We have used 652.20 in the past if we can't use this one, what code should we use?
SuperCoder Answered Wed 10th of March, 2010 14:32:30 PM
652.20 is a code for complications which occurs during birth of a baby, so this a code used for a pregnant women only. So to code this you must first determine the reason why an ultrasound was done for this baby. It would be better if you could provide me some more details on this report.
SuperCoder Answered Wed 10th of March, 2010 15:11:02 PM
652.20 is a "mama code" only and cannot be billed when the patient is the baby. What Alex said is correct, you need to determine the cause (diagnostic condition) for which the US was done on the baby and choose a newborn code accordingly. For example, if the reason is congenital dislocation of hip, 754.3x is a correct choice. If no specific diagnostic reason mentioned for US, othjer than the breech delivery reason, you can pick up 763.0 as a code. I am not comfortable with the code V82.3, if the Dx for US is already confirmed (that code is to be used when the Dx is not confirmed and US is used as a screening Px only).
Jan Posted Wed 10th of March, 2010 15:18:32 PM
We send all our breeched babies over for a hip ultrasound to rule out any hip anomalies. How about using 760.9?
SuperCoder Answered Wed 10th of March, 2010 16:38:12 PM
Well, if there is no specific Dx for sending the baby for US, you may use 760.9.
However, I would like to mention that as the practice of performing a US to all the newborns is a routine kind, there are several instances where insurances have turned down the claims for a US, citing that the US is a routine one and no specific medical necessity was mentioned! Moreover 760.9 is an "unspecified code". Therefore there is quite a good chance that you may receive a denial on these two grounds. Showing a medical necessity for performing US is always a better option, to be on a safer side.
SuperCoder Answered Wed 10th of March, 2010 16:48:48 PM
Forgot to mention, using V82.9 (bcoz the US is for screening purpose only, not for some confirmed Dx) or 763.9 is better option, rather than using 760.9 (there's no mention of a complication from breech or any other maternal problem as source of any complication of baby).