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Thread: Not submitting all codes

  1. #1

    Default Not submitting all codes

    AAPC: Back to School
    Just have a few questions...if a patient comes in for infertility issues as her chief complaint but also discussions other female issues and the dr listed both codes isn't it wrong to drop the infertility code because it won't get paid and it would "label" the patient? Same goes for obesity?
    What about when the office has been told they are going to be audited and are told what patient files will be reviewed they scramble to recheck and double check that they haven't missed anything and if had they change things before the review to make it appear nothing was wrong? What about charging a state aided patient a no show fee for a missed appointment isn't that wrong or illegal? Or what if when billing an insurance for a global maternity service they are also charging the initial office visit seperately, shouldn't that be included as global? As you can see i have alot of questions and/or concerns, any help would be appreciated;

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    #1 - you cannot make a visit for what it isn't in order to get paid for what it is - Meaning if the visit is for infertility then that is your first listed dx along with the other diagnosis discussed, the same goes for obesity or any other condition. It is wrong to use a payable dx code to disguise an otherwise non payable encounter and could be interpreted as deliberate misrepresentation.
    #2 - Once the claim has been submitted the documentation cannot be altered. To "dress up" the documentation prior to an audit in order to represent what was billed on the claim is a very serious charge. DO NOT PARTICIPATE in this kind of activity EVER.
    #3 - CMS has stated you may charge for no show visits as long as you charge all patients for no show encounters unless prohibited by state rule or contract. So check with your state payer.
    #4 - To determine whether a patient is pregnant (V72.4x) can be billed as an office visit separate from the global. However once pregnancy is confirmed either by an doc outside your practice or your doc then the next visit initiates the global (V22.1 or V22.0) and may not be charge separate.

    Debra A. Mitchell, MSPH, CPC-H

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