Wiki Butting heads with my providers

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kparker1980

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Hi everyone :)

I am butting heads with my providers regarding a coding issue, surprise surprise right? LOL. Anyway, I have been going back and forth about this issue with them for weeks now, and I really need some form of concrete documentation to bring back to them. I do OBGYN coding and I code for 5 or so different providers. One of my providers keeps using code Z30.8 and putting the description as "Surveillance for birth control, vasectomy". She is trying to code for the patient using her partner's vasectomy as her form of birth control. These codes are mostly being used on annual GYN encounters. I tried to explain that this code cannot be used on the patient's encounter because it is not HER vasectomy, it is her partner's and that it is NOT a form of contraceptive. I explained that the definition of contraception is "a device or drug serving to prevent pregnancy". The provider keeps stating that his vasectomy is the patient's contraception. In the real world I understand where she is coming from, obviously someone that is married and their husband has a vasectomy, is going to feel that they don't need to use any form of birth control. That's fine, but from a coding standpoint, I don't agree that we should be documenting this as her contraception when HE is the one that had the surgery. I think this should be left off of the encounter altogether. Can anyone please help me with this, give me some outside perspective and possibly some concrete information that I can go back to my providers with? Thank you!! :) :)

Kim P.
 
Hipaa/phi

Hey Kim,

I might try the angle of HIPAA and protection of PHI. Specifically, in regards to HIPAA, if I had the vasectomy done and the vasectomy was mentioned in my wife's medical chart, I would (politely) ask for them to remove that from her record. Frankly, I don't think my wife would want that in her medical records either. Why does anyone need to know? Is it absolutely essential to the main dx that we know the form of contraception, especially if the patient herself is not involved?

Actually, I would want a provider to see him, to check on the status of the contraceptive management, and his wife's name would be an integral part of his medical chart. If he was seen, then Z30.8 makes perfect sense for his chart. (!)

In my mind, even with the closeness of some married couples, patient records have to be kept separate. Yes there are times when certain information overlaps (i.e. spouse, mother, and father is mentioned in charts), and of course we often have family medical history and social history. But most medical information has to remain separate to maintain confidentiality of PHI per HIPAA.

Is there a code for vasectomy of a partner in ICD-10-CM? I couldn't find one... and while I can understand how the provider sees his vasectomy as directly related to her health (which it obviously is), I would encourage you to be persistent, and in the kindest way possible, continue to give them the coders point of view.

Sincerely,
Jacob
 
Thank you Jacob! I hadn't even thought of it that way. I agree 100% that it should not be coded, and that is part of the fight that I am having with them, is that this is HIS vasectomy, it has nothing to do with her personal health (even though in real life, she depends on him to not get pregnant). Logically anyone can argue that it is her form of "birth control" but from a coding standpoint that is not the case. Almost like the golden rule of "if it wasn't documented it didn't happen", it isn't her sterilization so it shouldn't be documented. I have looked everywhere trying to find a code for this, and as you know from searching there is not a code that works. I even sent an email to CMS, and they couldn't help me. I guess I will have to do what you said and politely be persistent with this. Problem is, they are trying to be sneaky and code this with Z30.09. I caught one of them using that code for it, and underneath it said "partner has vasectomy". I guess they don't realize I actually read the chart when I am coding LOL.
 
Insurance angle

Hey Kim,

That's interesting. Indeed, it seems persistence is not easy, but once they understand the value of accurate coding, it seems they will be less likely to continue.

We could approach this from the angle of denials from insurance companies too. I don't know if contacting the insurance company directly and asking about this Z code situation is within our radar... Do you think the patient's insurance will accept the claim with that Z code? Interestingly enough, receiving a denial might be the exact proof needed for the providers, to show them that this particular Z code is not accurate. But, just a thought...

Thanks very much for sharing your experience. I appreciate getting insight into actual situations communicating with providers.

Sincerely,
Jacob
 
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