Wiki injury "S" codes

[debdebc]

I have an insurance that keeps denying claims for the injury codes stating that these codes should never be used as primary dx codes and that an underlying disease codes needs to be primary. Not having a problem with any of the other insurance companies with these codes so if the pt comes in for the injury and they are not in any pain or no infection or nothing going on, how do you code these claims. Thanks for all the help!

 

[Lashel]

I have an insurance that keeps denying claims for the injury codes stating that these codes should never be used as primary dx codes and that an underlying disease codes needs to be primary. Not having a problem with any of the other insurance companies with these codes so if the pt comes in for the injury and they are not in any pain or no infection or nothing going on, how do you code these claims. Thanks for all the help!

Is it any S codes in particular? It sounds like they have some kind on internal/computer issue. If they are unspecified codes that also could be your issue. I have never heard that S codes can't be primary. That is nonsense. So if you fracture your radius that isn't a primary dx to seek treatment?

 

[daedolos]

If you haven't called in to your insurer to speak with an actual rep, you'd be surprised at how many claims automatically deny due to a computer programming glitch (i.e. automatic denial). Half the calls I make result in the rep stating that the computer automatically denies a claim and a followup will require a phone call. For example, I just called in to Molina this morning and explained that 29075 needs only a laterality modifier as the EOB stated that modifier is missing. The rep told me she didn't know why the computer always does this but that she will forward the bill to their billing department for reconsideration. At least the hold time was less than a minute. Another example are claims for multiple body parts which require a different case number per workman's comp regulations that are evaluated on the same day. Any multiple claims for the same patient done on the same day regardless of different case numbers will be automatically denied by the DOL as duplicates until you either call in to a rep or send in an adjustment request form.

That said, S codes are acceptable as primary diagnoses. Just make sure they are not unspecified and/or the laterality matches for the CPT code assigned to the procedure rendered just as Lashel said.

Peace
@_*

 

[debdebc]

Is it any S codes in particular? It sounds like they have some kind on internal/computer issue. If they are unspecified codes that also could be your issue. I have never heard that S codes can't be primary. That is nonsense. So if you fracture your radius that isn't a primary dx to seek treatment?

Thank you so much for the information. I appreciate it!

 

[debdebc]

If you haven't called in to your insurer to speak with an actual rep, you'd be surprised at how many claims automatically deny due to a computer programming glitch (i.e. automatic denial). Half the calls I make result in the rep stating that the computer automatically denies a claim and a followup will require a phone call. For example, I just called in to Molina this morning and explained that 29075 needs only a laterality modifier as the EOB stated that modifier is missing. The rep told me she didn't know why the computer always does this but that she will forward the bill to their billing department for reconsideration. At least the hold time was less than a minute. Another example are claims for multiple body parts which require a different case number per workman's comp regulations that are evaluated on the same day. Any multiple claims for the same patient done on the same day regardless of different case numbers will be automatically denied by the DOL as duplicates until you either call in to a rep or send in an adjustment request form.

That said, S codes are acceptable as primary diagnoses. Just make sure they are not unspecified and/or the laterality matches for the CPT code assigned to the procedure rendered just as Lashel said.

Peace
@_*

Thank you so much for your help! I appreciate it!

 

[shreemannari123]

Also "S" unspecified injury codes are to be used even though one knows pt fell or had an mva. This must be an internal edit with insurance company's software. Hope this helps.