Primary Care Coding Alert

Question: A patient comes into the office to see the physician for injuries resulting from a motor vehicle accident. While being seen by the physician, the patient asks to have a medical condition such as diabetes checked (250.0X). May the doctor bill an evaluation and management (E/M) code to both the motor vehicle insurer and personal insurance, or should he bill the E/M to the automobile insurer and the diagnostic laboratory test to the personal insurance?

Janice Grimm
Abington Memorial Hospital, Abington, Pa.

Answer: Determine whether there is coordination of benefits between automobile insurance and health insurance carriers in your area or state. This fact will be crucial if one of the two carriers denies the submitted claim.

In this particular case, there are two distinct diagnoses for the two services rendered and you must be sure to appropriately link the correct diagnosis with the particular service rendered. The auto insurance will be responsible only for the portion of the bill that involved treating the patient in regard to the motor vehicle accident (MVA), not for treating the diabetes. So the automobile insurance carrier should be billed only for the services related to the injury diagnosis and not those related to the medical condition (diabetes).

If only a diagnostic procedure such as a blood test (82947, glucose, quantitative) was performed for the diabetes and no additional separately identifiable amount of time was spent addressing the diabetes, that should be the portion billed to the health insurance carrier.