Question: Medicaid denies our claim for a case involving a D&C due to postpartum bleeding. We submitted diagnosis 627.1 (Postmenopausal bleeding), but Medicaid wants an E/M code instead. What should we report?
Louisiana Subscriber
Answer: The carrier might be requesting an E/M code because of confusion with the diagnosis you submitted. Begin by taking another look at the diagnosis code. Code 627.1 is for postmenopausal bleeding; 666.14 (Other immediate postpartum hemorrhage; postpartum condition or complication) is for postpartum bleeding. Other codes in the 666.xx family also apply to postpartum hemorrhage, so check those as well for the most appropriate choice.