WesMel
New
We are getting audited by HealthEZ. They have given us a list of unacceptable principal diagnosis codes. They want us to code what the principle diagnosis was for bringing her into the hospital. They are saying the following codes (and others) are not allowable as principal diagnosis codes based on CMS coding:
O34.211 Previous C-section scar
O32.1xx0 Maternal care for breech presentation
O36.5930 IUFD
The list goes on but my question is what in the world are we supposed to use?
Someone within our group handling the refund requests from the auditor is telling us that if we aren't using O80 or O82 then they are looking for complications of pregnancy codes O60-O77.9.
Ok so does that mean I have to use O65.5 for a schedule repeat c-section and O64.1 for a scheduled c-section for breech presentation?
I'm just unsure on how we would use an "obstruction of labor" code on scheduled c-sections where the patient never went into labor. Are we really calling a previous c-section or a previous myomectomy scar, obstructed labor?
I have no clue what we are supposed to used for a patient who for instance has a fetal demise at 26 weeks and is scheduled for an induction since apparently O36.5930 is an unacceptable principle diagnosis on the list as well.
Fetal demise WAS the principle reason we sent her to the hospital to induce her. What else could we use here?
I appreciate any help.
O34.211 Previous C-section scar
O32.1xx0 Maternal care for breech presentation
O36.5930 IUFD
The list goes on but my question is what in the world are we supposed to use?
Someone within our group handling the refund requests from the auditor is telling us that if we aren't using O80 or O82 then they are looking for complications of pregnancy codes O60-O77.9.
Ok so does that mean I have to use O65.5 for a schedule repeat c-section and O64.1 for a scheduled c-section for breech presentation?
I'm just unsure on how we would use an "obstruction of labor" code on scheduled c-sections where the patient never went into labor. Are we really calling a previous c-section or a previous myomectomy scar, obstructed labor?
I have no clue what we are supposed to used for a patient who for instance has a fetal demise at 26 weeks and is scheduled for an induction since apparently O36.5930 is an unacceptable principle diagnosis on the list as well.
Fetal demise WAS the principle reason we sent her to the hospital to induce her. What else could we use here?
I appreciate any help.
diagnosis codes, diagnosis coding
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