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Need Help V26.49 vs V72.41

  1. Default Need Help V26.49 vs V72.41
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    Hello fellow coders. I need your help. I am a coder, but do not work in OB/GYN. I am currently fighting my own claim with my doctor's office. I had a visit because I thought I was pregnant. They did a urine preganacy test (which came back negative). They said it was probably to early to detect. They recommended that I avoid caffeine, keep taking my prenatal vitamins, and come back the following week for another urine test. They also sent me for a blood test (hcg quant). They billed the claim to my insurance company with the primary diagnosis code of V26.49 because they say the advice about caffeine and vitamins was procreative counseling. The claim for the visit and the claim for the lab were denied because the insurance company considers this an infertility code. I looked up codes and asked my doctor's office to resubmit with primary diagnosis V72.41 because this was the main reason/focus of the visit. They say their code is correct and refuse to resubmit. This leaves me stuck with the full bill for the visit and the lab because of the code. I don't code OB/GYN, but my code makes more sense to me. Am I way off base? Can anyone help?

  2. #2
    Mrs Lindley

    I agree with your code. The reason was the pregnancy test and the outcome dx should be coded. The definition states: Pregnancy examination or test, negative pregnancy.

    V26.49 definition states: Other procreative management, counseling and advise. The description falls under general counseling and advice, so I can see why the office would like to select this due to the counseling provided.

    But, as you say, the reason for the visit was not counseling, but the pregnancy test. The result was negative and the counseling for the results are included/ or part of this. I wonder if you could talk to your insurance on how to handle the situation.

    Pregnancy testing encounters are codd based on the results of the test or exam that are known at the time of the encounter.

    Good luck
    The Oracle

  3. Default
    MJ4ever is correct. You should definitely argue this one. Good luck!

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