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Need Diagnosis Help

  1. #1
    Minot ND
    Default Need Diagnosis Help
    Medical Coding Books
    I work for 2 ophthalmologists who are called over to the hospital to eval premature infants for possible Retinopathy of Prematurity. The problem I have is most of these infants don't have it (thankfully) and so I can't use that as my diagnosis. The ophthalmologists have then been coding 765.1x and 765.2x but I'm getting denials from insurance as the babies are sometimes older than 28 days. I have mentioned the V71.89 code however they don't like that as it's too vague. Is there any other code I can use for suspected problems due to prematurity?? Any insight would be helpful.

  2. #2
    I think assigning both the Observation code and the prematurity codes explains the scenario as your physicians are observing for a suspected condition in a premature infant.

    Hope that makes sense!
    Shirley K.C, BPT, CPC - H
    Have a nice day!

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