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935.1 and occurrence codes

  1. #1
    Location
    Pensacola, Florida
    Posts
    279
    Default 935.1 and occurrence codes
    Medical Coding Books
    Our physician removed an esophageal foreign body. We submitted 43247 with 935.1. This has been our practice for some time. Now this is hitting an edit with our clearinghouse. They state we need to attach occurrence codes. We have never had to do this, yet our clearinghouse states it has always been an edit. We use Payer Path.
    Everything I read about occurrence codes, indicates they are used for accidents and injuries. Has anyone encountered this, or use occurrence codes? We sometimes have no way of knowing the exact date of the s/s, or "incident".
    Thanks!

  2. Default
    Yes I have received a denial from one of our clearinghouses for that before. Check out the E911 or the E912 accident code depending on if it is food or something else. Depending on your software you may have a place to enter accident codes, or you may have to enter them as a diagnosis code.

    Bob

  3. #3
    Location
    Pensacola, Florida
    Posts
    279
    Default
    I orginally had the E-code on the claim, and thought that might be part of the problem. when I removed the E-code, it made no difference. There is a place for us to enter the occurrence codes, but I don't know what date to put if we don't know the exact date of the "occurrence".

  4. #4
    Default
    Some things in common about the rejections from our clearing house is that they are all UB claims and the insurance is Humana Medicare. No problems so far with other insurances.

    And with our old clearing house, we've never had these rejections.
    Redditor? Come join our coding/billing discussions on Reddit.

  5. #5
    Default
    sometimes you have to use your best guess on the date of occurance if you don't have a specific date...this has always worked for me....if the insurance co. has more questions, since it's considered an accident, they usually will send an accident questionnaire to the patient for clarification

  6. Default
    I am having this issue with Great West, we billed 43239 with 935.1. Were you able to fix this problem, and how? We also, use Pather Path as our clearing house. I tried using the E-code, but this did not help.
    Thank you,
    Annette

  7. #7
    Location
    Charlotte, NC
    Posts
    534
    Default
    The occurence code we use is 11 with all foreign body removals. We use Allscripts/Payerpath for our clearinghouse.

    I have no idea why or what it signifies, my supervisor told us that is what we use.

    And usually the date of the occurence is the date seen/first date of treatment.

  8. #8
    Location
    Pensacola, Florida
    Posts
    279
    Default
    Annette,
    I ended up using occurrence code 11, and entered in the date of the procedure as the date of the s/s or "accident". It went through Payerpath, but still doesn't explain why we never had to do this before until we switched to Allscripts/Payerpath. The only other thing I have been able to come up with is perhaps it was because it was done in our Endoscpoy Center and POS has something to do with it. We never get this edit when entering this code for out-patient hospital (POS 22).

    Bridgette

  9. Default
    Thank you, so much.
    Annette

  10. #10
    Location
    Charlotte, NC
    Posts
    534
    Default
    Glad that helped.

    We've been told anytime we use a "900" code as primary dx to use the date of service as the date of occurence. But we only usually use them for our ER/OP hospital procedures and not the Endo center.

    According to a printout we have from Payerpath, I believe, Occurence Code 11 is for Onset of Symptoms/Illness which they define as (for Outpatient claims only) date that the patient first became aware of symptoms/illness.

    So for an ER or OP date of service is usually date of onset. At an Endo Center (ASC), was it scheduled? Stent removal? If it was a scheduled stent removal I'd use V58.82. Otherwise I'd use date the pt first called for appt.

    But anytime we use 43247,43269 or 45379 you use the occurence code 11 and if we use a "900 code" under ailment info you put brief hospitalization, date of first symptom, and accident info if any.

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