Pediatric Coding Alert

Question: We just got a denial for an X-ray performed on a 6-week-old patient. Our pediatrician documented that the reason for the service was "to check the status of the hips, as the baby was breech." The results came back normal, and they do not state there were any signs or symptoms or any concerns for hip problems. The insurance has denied 73502 with P03.0 and is asking for a problem diagnosis. How should we deal with this?

Oregon Subscriber

Answer: The issue here is that P03.0 (Newborn affected by breech delivery and extraction) is not a problem diagnosis, so the payer is probably denying because of that.

Instead, your best bet would be to link 73502 (Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views) with a screening code such as Z13.828 (Encounter for screening for other musculoskeletal disorder) in the absence of a definitive diagnosis to link with the X-ray. But check with the payer first to see if this is the preferred code to link with the service.