Primary Care Coding Alert

Question: We received a denial for a claim describing services provided to a patient who had been bitten by a dog. I used 99213 (office or other outpatient visit, established patient) to describe the office visit and seven stitches to the patient's leg. We also reported 90788 (intramuscular injection of antibiotic [specify]) because we gave the patient a prophylactic dose of antibiotic. I used E906.0 as the diagnosis code. Can you tell me why this wasn't paid?

Wisconsin Subscriber

Answer: Most likely the denial is a result of your use of the E code as your primary diagnosis (E906.0, dog bite). E codes should never be the only diagnosis code submitted, nor should they be listed first on the claim form. E codes are used to explain what happened to cause the injury that is being treated -- they do not, however, describe the medical reason the patient is being seen. Therefore, E codes should be listed in the secondary or tertiary position. Instead, the primary diagnosis should have been 891.0 (open wound of knee, leg [except thigh], and ankle; without mention of complication).

Some coders say they remember how to properly assign E codes by linking the letter "E" with the word "explain." 

 -- This month's "You Be the Coder" and "Reader Questions" were answered by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City, IA; and Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians.