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Thread: help please

  1. #1
    Join Date
    Apr 2007
    Posts
    20

    Default help please

    Promo: Code Books
    We had a patient go to her Family Practioner for a pre op visit after a car accident. On exam she was noted to have an abnormal EKG and her FP referred her to our Cardiologist. Our Cardiologist sent her for an Echo and then wants her to have a nuclear stress test. The patient is insisting on us billing her no-fault insurance and some people in our hospital billing office agree. I feel that this is a medical problem and should be billed to her medical insurance. Can you help us decide?

  2. #2
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,168

    Default

    To bill to the no fault then the physician must tie the abnormality to the accident as accident related.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Wink

    Sounds to me like the cardiac finding was just an incidental finding during the motor vehicle accident work-up. This happens all the time and most often, these findings cannot be tied to the motor vehicle accident.

    Of particular interest and on a funny note, several years ago, we had a patient who came in because she was involved in an automobile accident and on working her up for her injuries, it was determined that she was pregnant - news to her! Well, this lady wanted us to include this in her no fault benefits.

    Your lady needs to thanks her lucky stars that because of the car accident, she was fortunate enough to find out before it was too late that she is the proud owner of a cardiac condition. At least she can obtain treatment while she is alive and kicking and not have to had to wait until she possibly had a fatal heart attack.

    Good luck convincing her

  4. #4
    Join Date
    Apr 2007
    Location
    Portland Metro
    Posts
    65

    Default

    ...Hmmm...what if she got pregnant in the car?
    Hmm, it's collision, isn't it?
    Hope the other driver had liability!
    (Sorry, being silly...)

  5. #5

    Default

    I too would have to agree that the cardiac condition is incidental. The physician would have to have documentation stating this was a result of the car accident. The patient's insurance should be billed. Sure you could bill the auto insurance but I am sure they would reject this for the above reason.

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