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Well Baby Care Scenerio

  1. Default Well Baby Care
    Medical Coding Books

    V20.3 Dx code

    ins denied claim, contains coding which has been discontinued or labled as invalid

    Customer serv rep said claim was submitted with invalid place of service code 99

    working on the corrected claim and wanted to change the POS codes but was wondering if V20.3 is causing problems as well..
    any input is appreciated.
    Last edited by jans04; 10-19-2011 at 04:23 PM.

  2. #2
    V20.3 should have a fifth digit. Judging by the diagnosis you have chosen your provider has seen an infant most likely under 8 days old (V20.31) and also based on the 99460 code you have chosen.

    99391 should have a V20.32 or V20.2 depending on carrier preference though specificity would point to V20.32.

    And on the 84030, am curious if you actually drew blood or was it a pku card that was performed? If it's the regular newborn pku screening kit then the diag best suited is V77.3 and some carriers prefer the S code hcpcs or the 36416 for the heel stick.

    It's difficult to know exactly without more detail but this should at least get you started.

  3. Default
    Thank you Victoria. Yes I agree with the 5th digit, child was born on the same DOS of 4/16/2011
    Im puzzled as well on the 84030 because I dont have the notes from the Dr yet. Once i have the notes, then I will have a better picture as to how correct the claim.
    The provider of service billed the claim just as I described it so it was denied. Im working with the pt's father as his advocate to have the claim appealed and paid. The dad paid for the claim in full because the provider billed him for the denied charges.
    POS 21 is good on the 99460 or what do you normally use?
    Thanks again for your input :-)

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