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Wiki HELP! Pregnancy coding.

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louvad

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In my daughter's 5th month of pregnancy, she was admitted to the hospital for 2 days due to dehydration and fever. She received 4 bags of IV fluids and was treated with higher than usual doses of Tylenol for her resistant fever. Her insurance denied the claim because the hospital used a primary code of "Other Maternal Services." They are refusing to change the code, which they say is correct. They state that she was admitted because she was pregnant; obviously, she was admitted due to dehydration and fever. I was taught that this type of code should never be used as a primary code. How can I help her?
 
I'd fight it! They should have coded the fever and dehydration first, then maybe v22.2 for 'incidental pregnanct'-sounds like she had a virus that made her feverish and sick, NOT the pregnancy itself. Call the hospital's billing dept. and ask for a manager or coding complaince dept.
 
Thanks mcnaryk. That's exactly what I thought. I informed my daughter and she will be contacting the hospital. I really appreciate your reply. I am still an CPC-A, so I wanted to check before I had her question "experienced" coders. You made my day. :o)
 
You cannot call it V22.2 unless the physician specifically documents this condition is not complicating the management of the pregnancy. They should have used a 648.xx code first with the dehydration secondaey. Chapter 11 codes have sequencing priority and alwYs go first. Read your coding guidelines first before you assume they are incorrect.
 
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