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coding for billing requirements vs actual general medical codes

  1. Question coding for billing requirements vs actual general medical codes
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    Situation: Medicaid requires a distinct code to be used v05.3 for hepatitis immunization.

    The patient 5 year old child comes in for a well visit, no other problems other than wellness. The doctor uses dx code V20.2. Reviewing the record we see that a hepatitis immuniztion was given, is it kosher to change the record to show V05.3 for the hepatitis, while leaving the office visit with dx V20.2. Or do we need to get the doctor to change the code from V20.2 to V05.3 for the hepatitis immunization.

  2. #2
    Always follow the payer's guidelines. In this case, use V05.3 with hepatitis imm. Leave V20.2 with the office visit and you could add V05.3 as second dx.

    We have a tendency to get stuck with coding guidelines only. We have to follow payer's guidelines or we will not get paid.

    Hope this helps.

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