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mitchellde said:
What dx code are you using for first-listed and what does the rejection indicate?
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They are using for example:

Patient is in rehab for a FX hip and we are seeing them for diabetes. We are billing 99307 - 61. The diagnosis is 250.00, they are not billing the FX because another dr. already is seeing them for that.
 
I think the 61 is the place of service code for rehab... otherwise I am confused. If the reason for the stay is rehab then the first listed dx is required to be V57.x. If your physician is seeing the patient for reasons other than the rehab for instance just for their diabetes and is not managing the rehab at all then I agree with your dx code. However if he is in any way managing the rehab services in addition to the diabetes then you must use the V57.x code first-listed. What did the payer state as the reason for the rejection
 
Thanks Debra.

So, even though the Dr. is following up on the patient's (diabetes, htn, COPD, etc) I should have the V57.X code listed first? Ex. V57.0, 250.00
 
I'm saying that is a strong possibility, given the patient is there for the purpose of rehab and the other dx are simple the patient's chronic problems with nothing else symptomatic. What did the payer give as a rejection rationale?
 
I have ask the coordinator to send me the H-Reports so I can take a look at why they were denied. She called me on the phone to ask this question and I tried to answer as best as I could, but got stumped when she said she had quite a few claims that were rejected and couldn't tell me the reason. I'll keep you posted.

Thanks again.
 
Here is the reason quoted -- pt was enrolled in skilled nursing facility. SNF info is needed to bill for payment.
 
So the place of service should be 31 not 61. Maybe that is the only problem, which would be an easy fix.

Laura, CPC, CEMC
 
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