Hi All -
I KNOW I can not possibly be the first or only coder with this issue, but it's a first for me. We have a 60 year old patient who is a true hermaphrodite. Has a phallus and small testes, but also menstruates and lactates. (Literally, she has ALL the parts.) Patient was seen (I code for Urology) for a scrotal mass. Diagnoses used on the claim by the doctor was N50.811 (right testicular pain & D29.31 (benign neo of right epididymis). Claim clearinghouse rejected the claim because patient identifies female. I added the true hermaphrodite diagnosis of Q99.1 -which, by all logic should override the remainder of the diagnoses. But it didn't. There's nothing else clinical that can be added - I discussed with the doctor. We can not get the claim to pass thru PayerPath, and I'm out of ideas. It's Medicare, so it's not like we can drop it to paper. Can anyone else shed light on how I can get this claim to pass edits? I can't exactly remove diagnoses, especially since the patient is scheduled for surgery at the end of the month.
Thank you!!
I KNOW I can not possibly be the first or only coder with this issue, but it's a first for me. We have a 60 year old patient who is a true hermaphrodite. Has a phallus and small testes, but also menstruates and lactates. (Literally, she has ALL the parts.) Patient was seen (I code for Urology) for a scrotal mass. Diagnoses used on the claim by the doctor was N50.811 (right testicular pain & D29.31 (benign neo of right epididymis). Claim clearinghouse rejected the claim because patient identifies female. I added the true hermaphrodite diagnosis of Q99.1 -which, by all logic should override the remainder of the diagnoses. But it didn't. There's nothing else clinical that can be added - I discussed with the doctor. We can not get the claim to pass thru PayerPath, and I'm out of ideas. It's Medicare, so it's not like we can drop it to paper. Can anyone else shed light on how I can get this claim to pass edits? I can't exactly remove diagnoses, especially since the patient is scheduled for surgery at the end of the month.
Thank you!!