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Wiki Repeat ER visit due to missed diagnosis

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sjfarnsworth

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Is there a bounce back rule that applies to a repeat visit to the ER after an initial missed diagnosis. The repeat visit was one week after the initial visit.
Same presenting complaints, end diagnosis after second visit was "Pyelonephritis".
 
What do you mean by a 'missed diagnosis' - does the documentation suggest that the initial provider did not diagnose or treat the patient appropriately the first time? If that's the case, your organization make want to make some kind of exception for this patient, depending on the circumstances, so you may want to direct this to your manager or to a supervising physician to conduct a clinical review if you think it is warranted and get their direction on how to proceed.

But there is no coding rule for such a situation, that I've ever heard of, and I don't think you'll find anything that says that you should code a visit differently if a patient has to return because symptoms did not resolve - that's a common situation and the visits are not coded any differently than usual.
 
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Most medical insurance companies have an edit for visits on the same day by the same specialty. So 7 days apart should not be a problem especially with a different diagnosis. If there is a denial, simply sending in the records for both visits for review should take care of the issue of approval for payment.
 
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