medication

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while coding for an outpatient service if the provider orders an medication not related to the current diagnosis but its for some prophylactic measures or prevent something else.
same situation about the labs and x- rays if it is done for some unrelated purpose other than current diagnosis just to check the probability of any condition.. and the insuarance will reject the services on the base of (no medical necessity).... so how to go with these kine of situation...
I request all the coders out there to please help me with this......
Thanks to all in advance..... :)
 

mitchellde

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There are dx codes for prophylactic measures. Look in the V code section. As far as you diagnostic studies to check for the probability, are you talking about screening? perhaps? without more information and a specific example it is hard to provide more direction.
 
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thanks Mitchell.....

:)

thanks for the reply it helped with most of the things....


the classic example for which i would like to be clarified is.....

if the provider mention the diagnosis of upper respiratory tract infections (465.9)and he prescribes an antibiotic .......

the reason for that is...............sometimes providers prescribe antibiotics to shorten the course of the illness and decrease treatment failure..


and the insurance will reject the antibiotic on the basis of (no medical necessity) as most of the URI are result of viral infection.......



and second example for lab test is like if the patient comes for headache and during the discussion with patient, provider orders.... suspecting the condition of hypertension
and to start up with his investigation some lab test like
Urinalysis, Urine protein
so that lab will also get rejected with the same reason (no medical necessity) because of no confirm diagnosis .

thank you once again.... :)
 

mitchellde

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I am not sure why you are billing for the antibiotic, isn't he just prescribing the med? If documents a URI then that is the patient's dx and what you must code .. this should pair to the office level , what else are you billing?
As far as the suspected HTN you can bill the symptoms and if the dx is not confirmed you can use a V71.7 first listed followed by the symptoms to a condition suspected but not found.
 
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once again thanks Mitchell.....

thanks for taking out your valuable time and reverting back......

sorry to bother you but now i am pairing it with suitable documentation to office level ....... previously sometimes i use to separately bill for pharmacy prescriptions... at that time problem was occurring..... but now its fine.......

and thank you for that second situation..........

:)
 
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