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Next Reply: Re:correct code
Previous Message: Using the V 66.7 Palliative Code
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Post correct code
Author: Judy
Date: Jan 21, 2008 2:47 pm
I've had claims denied for using 293.0 in patients who develop delirium prior to death because coverage didn't include "mental health".
Have other programs had this problem? I'm using the V66.7 with these claims and the code for their terminal illness. Any suggestions?
Replies: order by [Date] [Author] [Subject]
Re:correct code (by SharolHerr on 01/23/2008)
At Mount Carmel Health we have not had any problems with denials of delirium as a diagnosis. Dr. Phil Santa-Emma is our medical director and has had extensive experience with successful billing. He passes along the following comments. When we began, billing symptoms such as anxiety and delirium were scrutinzed but after clarification and some "push back" we have been successful in using these codes. If you are using the diagnosis code you run the risk of coding for the same diagnosis as the attending physician on the same day. Attendings would not respond well to being denied because of the palliative consultant billing for the diagnosis code. Their really isn't a role for the V code in billing. It is not pertinent to the individual patient and is not reimbursed.

Sharol Herr, RN, MSEd, CHPN
Nurse Clinician/Education Coordinator
Mt. Carmel Health System
Palliative Care Leadership Centers
Columbus, Ohio
Re:correct code (by SharolHerr on 02/04/2008)
I have some additional information from our medical records department re: use of V code.

"The Med Par data is based on the coding that is submitted on the bills to Medicare. We can report a total of 1 principal and 9 secondary diagnosis codes. We make sure that the V 66.7 is sequenced in the 9 secondary to ensure it is submitted and in the Med Par data. Within our internal data base we do store numerous codes, however for billing and DSS only the top 10 are reported and stored."

Sharol Herr, RN, MSEd, CHPN
Nurse Clinician/Education Coordinator
Mt. Carmel Health System
Palliative Care Leadership Centers
Columbus, Ohio
Re:correct code (by Judy on 02/04/2008)
Thank you for your feedback. Because the palliative care doctor and the group of hospitalists bill under the same tax ID number, we use the V66.7 when billing for in-patient E/M codes along with the -77 modifier to avoid denials for duplicate days of service. It has reduced the denials but not eliminated them altogether. On a 1500, there is only room for 4 diagnoses and the V66.7 is the final code. I code mostly symptoms but sometimes code sequencing mandates that I use the same codes the attending will be using and then we appeal if one of the services gets denied. I've gone back to using 780.09 code for delirium even though I think the 293.0 is a more accurate and specific code for the condition. Thank you again for your responses.

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