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hannahw101

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Please help...Medicare has rejected all my codes for the following scenario
patient already admitted to a pysch hospital fell down and hurt her head.Was brought in to a medical unit in the same hospital and pysician wrote in his note that she had a subdural hematoma .I coded it as 852.31 it was rejected..ive also tried 920 and 959.01 and all have been rejected..Does any one out there know why? am getting desperate..
 
Re' -subdural Hematoma

Believe It Or Not But I've Coded A Sim Situation With The Dx Code Of432.1 - Although It Says Non Traumatic, The Claim Was Paid.
 
If it is a traumatic subdural hematoma the 432.1 code would be inappropriate. Is this a psych provider? If so, maybe that's why the insurance company is denying a medical DX.
 
Psych related Dx

Dear hanna,

Since the patient is in Pscyh hospital, this might be the reason for your denial.
The patiet is having subdural hematoma due to trauma in his/her head. So this is the case you can't bill 432.2 since this is a non-traumatic code & you can't bill 959.01 or 920 since the patient is having subdural hematoma. Hope it's clear.

Code any pscyh related condition(s) as a primary dx and code the subdural hematoma as a secondary.

Hope this will help you!

Thanks
B.T.RamKumar, MBA, CPC.
 
Have you tried adding E codes to the claim? E88x.x (for the fall) and E849.x (for the place of occurance). This will give medicare little more information as to the circumstances surrounding the injury.
 
Did you also do the E codes and date of injury? All our 800-900's code have to have an E code and date of injury or the claim won't be sent out by the computer.
 
Medicare doesnt recognize E codes (at least ours doesnt). I agree with ramcpc, code the pysch condition first if you are coding for the pysch doc.
 
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