use of Ecodes in pediatric and insurance outpatient resourses

geminitc81

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I would like to know how many of you use Ecodes in a pediatric office?
i have been coding and billing injurys without the use of an Ecode i did ask about this and was told that the insurance companys dont care for it or dont pay.

Just wondering how everyone else feels about this? and also med check 90805ADD pt insurance companys dont pay for that either so it has to be billed a different way. Where could i go find more information some insuance companys are BCBSM,PRIORITY HEALTH,MEDICAID,COFINTY.I always thought that the guildlines in the ICD9 & CPT were the ones to look at, but i guess i need to find what insurance companys also look for thanks in advance for any advice.
 

007CPC

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I would like to know how many of you use Ecodes in a pediatric office?
i have been coding and billing injurys without the use of an Ecode i did ask about this and was told that the insurance companys dont care for it or dont pay.

Just wondering how everyone else feels about this? and also med check 90805ADD pt insurance companys dont pay for that either so it has to be billed a different way. Where could i go find more information some insuance companys are BCBSM,PRIORITY HEALTH,MEDICAID,COFINTY.I always thought that the guildlines in the ICD9 & CPT were the ones to look at, but i guess i need to find what insurance companys also look for thanks in advance for any advice.
Hi Geminitc81,

That is normal for E codes to be omitted in the corporate methodology. I had the same thought back when working as a ………… I always heard and still do hear coders in the clinical setting saying there is only one way to code and that is according to the insurance company guidelines which is true to an extent; but if you follow that semi-coding unorthodox trend you will end up coding unethically and breaching the COE.

So try your hardest to code according to the AHA, AMA, CMS guidelines while at the same time making the necessary adjustments to your code sequencing to get paid. Nothing makes me more upset when people abandon there morals in order to get paid;
“No matter what profession a person is in”
 

geminitc81

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Chad Malek

Well said! Thank you so much for your advice that is exactly how i feel when Im coding. Im always worried weither or not Im coding correctly becuz of the insurance guildlines and what they want.
But Im glad Im not the only one that feels that way Ive been on job for 3 months and i love it. The people are great and easy to talk too. Working hands on is different form what I was taught in class, but I will take your advice and try my best to code according to the AMA,CMS guildlines.
 

ARCPC9491

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This reminds me of my first job.

Diagnosis Rule #1 : We don't use E Codes EVER

Diagnosis Rule #2 : We don't use V codes unless we absolutely have to

Anyone else been told that at least once?:eek:
 

geminitc81

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LOL.....yea that was the frist thing that was mentioned we dont ever use Ecodes and the only Vcode we really use V20.2 for immms and physicals. Im just worried in the future if a consultant or someone in that nature comes and tells me "why do you code the way you code" as a CPC you should no better.
So tell me do code now with Ecodes and Vcodes?
and if so how did that happen?
 

ARCPC9491

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Well, I'm a consultant, and I don't code on daily basis for my full time job. I do however stay proficient in coding with a strong point in E/M. I do have other contracts where I independently code, which I do use E and V codes every time they are applicable. This is what we are taught, this is what the official ICD-9 guidelines say.

I find in private practice, E codes are often, if not always, overlooked.

I'd love to hear input from others on their use of E & V codes. If anyone audits for a payor, how do payors feel if these codes are or are not used? Do they ding the provider?

Inquiring minds want to know :)
 

bhaskins1

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It just seems like the Lazy approach to me if you are not coding correctly, just because it does not bring you extra reimbursement. I am in a pediatrics office and we use E-codes whenever appropriate. We see a lot of accidental injuries, vaccine reactions, etc... Compliance is a major issue now and cutting corners can only bring problems down the road. Now if I could just get the Knuckleheads up front to stop putting the E-code first...;)
 

kattekatt

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E Codes

We use E codes here where I am at but.... when I first started the data entry girl was told to use the E988.9 - unknown accident whenever the softwear prompted her to use an E code, she actually had a memo from the mgr on it- they still use the V20.2 with the immuz and so far unable to break them of that habit, unless they use the V05.9.

It is hard being the only certified coder in an office w/ 10 billers. They still make me at times question myself and get me all topsy turvy, but we do have a new mgr who is open and less defensive so hopefully... but the questions they ask me......... I am glad this board is here, I am going to need all the help i can in the future w/ this place.

Kat
 

bhaskins1

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I say... Welcome to the world of a coder and stick to your guns... it gets exhausting sometimes listening to the office staff say "but that's how we've always done it"... ok folks... that does not make it right. Show them your documentation and don't back down.... ultimately being the only certified coder in the bunch you have the most to lose in an audit. I don't know what your official title is but mine comes with a little authority so I started issuing Memos when something needed to be changed. This way I have documentation that I informed them of the correct way to code things. Good Luck and you are right... this forum is a wonderful tool to use when you have questions.
 

geminitc81

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Thank you all for all the advice

I am very thankfull that i found this job after getting my certifcaition with no experience. So I do mention coding guildlines to the office manger who is very understandable and is a great lishner, but I cant use some of things like the follow ........

1)E-codes - never use.

2) Med Checks - 90805 and 90862 only priority health all other ins bill as 99214 or 99215 becuz they wont pay for it. And sometimes the documentation does not support 99214 or 99215 which then i point out, she tells me to bill it and wright down the pts name and she will inform the dr. Im not really sure if the dr goes back and documents?

This is really bothering me I do have a job evalution coming up and I will mentioning these issues again but maybe more firmly........I dont wanna lose my job so ill be very pleasent LOL.

I have documention about E-codes and E/M codes Any ideas where abouts i can get documention on med checks?

THANKS ALOT THIS IS A GREAT PLACE TO TALK ABOUT CODING IDEAS AND ADVICE .

REGARDS
ARWA
 

KHaley321

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I'm at my second place of employment since I've gotten my CPC and I've used E-Codes in both places for anything that comes through that's supposed to have it by the official guidelines. We actually have a report now at my current job that tells us which patient's have diagnosis codes that still need an E-Code attached to it for completion in order for it to be billed. So it's a requirement where I'm at now. I also know that some payors to over look it, but I don't think it really hurts to have it either...:eek:
 

bhaskins1

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On the med checks... if the Doctor spends more than 50% of the office visit counseling the patient then you can code based on time for the 99211-99215 the trick is getting the doctor to notate time and % of time spent counseling. Another thing I would recommend is making sure you have your resources handy when discussing these things with the office manager... you will come across as very professional if you are able to state your position and then back it up with printed resources. You should also remind her that you are just concerned for the office in case of an audit and as a Certified Coder you feel it is your responsibility to point things out to her that are not in line with CMS Guidelines. A Wonderful resource for you would be the American Academy of Pediatrics Coding for Pediatrics book for 2009. I get a new one every year along with my coding books... the help it has given me has been immeasurable.

Take care... We are in the busy season in my office and I am not always in the forums but feel free to send me a private message if there is anything I can help with... coming from an office where I am the first and only coder on staff I feel your pain. I have initiated a lot of changes in my office just by doing what I said above... it's hard for them to argue with your position if you can show it to them in black and white.:D
 

ahansen

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ahansen,CPC

I use to be a biller before I became a became a coder.
So I am very familiar with the denials for the different insurances.
Now that I am a coder I always add the E-codes when appropriate.
One day I heard one of the billers rant and rave because we were using e-codes and she
was trying to get us coders to stop. So I asked what the denial
reason was, her not knowing, I took it upon my self to call the Payor
BCBSIL. Their program is not set up to take e-codes. So it was not
that we were wrong in billing the e-codes. So for this payor we put
the e-codes in the notes. So each payor may have similar problems.
It is always best to find out why the payor is dening the claim.
 
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