Medicare Patient - injury accident related

[cindtagg@gmail.com]

If a Medicare patient falls at a grocery store and fractures her wrist, how should the claim be submitted? Her fall was due to her climbing on a shelf at the store to reach an item, resulting in her fall, and subsequent fracture. I appreciate any guidance you can provide.

 

[mitchellde]

Code the fracture,
Then the external cause cod for climbing
Then the place code for grocery store
Activity code for shopping

 

[cindtagg@gmail.com]

Code the fracture,
Then the external cause cod for climbing
Then the place code for grocery store
Activity code for shopping

So would this be billed to Medicare or a third party payer (liability insurance carrier for the grocery store)?

 

[CodingKing]

Typically the liability insurance for the grocery store.

 

[cindtagg@gmail.com]

Typically the liability insurance for the grocery store.

Thank you very much!

 

[danskangel313]

It's also worth noting that Medicare MAY do a conditional payment after 120 days if the liability carrier is not paying up.

 

[CodingKing]

It's also worth noting that Medicare MAY do a conditional payment after 120 days if the liability carrier is not paying up.

Good to know. I'd question whether the store will try to fight it since it wasn't due to their negligence, however if treatment was limited i'm guessing they settle quick as its cheaper than taking to court.