I am a Medical Coder For a Rural Access Hospital and we are having a tremendous problem with getting claims paid with what is called a qualifier of PR (Patient Reason) for visit. Blue Cross of Idaho is stating it is separate from Primary Dx Code. I am coding a Primary Dx Code with a E Code and a V Code. Any Help Much Appreciated. Kim J Fisher
From what I could find online, a PR qualifier is used in hospital billing and cannot be a V code or an E code. It is the primary reason for the patient's visit to the hospital, it can be for outpatient visit. It is just the primary dx code, but you cannot use the V or E codes as primary.
National Standard Mapping:
Electronic - 837I
X12 Loop
Ref. Des.
Data Element
Code
Description
Version 4050R 2300 HI02-1 1270 PR Patient Reason For Visit Qualifier
1271 Patient Reason For Visit Code
Paper Form Locator Code Qualifier
Institutional - UB-04 70a-c N/A
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Definition:
The diagnosis describing the patient's stated reason for seeking care (or as stated by the patient's representative). This may be a condition representing patient distress, an injury, a poisoning, or a reason or condition (not an illness or injury) such as follow-up or pregnancy in labor. Report only one diagnosis code describing the patient's primary reason for seeking care.
Codes and Values:
1.Must be a valid ICD-9-CM code. To be valid, ICD-9-CM codes must be entered at the most specific level to which they are classified in the ICD-9-CM Tabular List. Three-digit codes further divided at the four-digit level must be entered using all four digits. Four-digit codes further subclassified at the five-digit level must be entered using all five digits. Failure to enter all required digits in the diagnosis codes will cause the record to be rejected.
2.Must be entered exactly as shown in the ICD-9-CM coding reference.
3.E-codes are not valid as Admitting Diagnosis Codes. E-codes are reported in External Cause-of-Injury Code and Place-of-Injury Code.
Example: HI*BK:63491*PR:63491~