Wiki E codes and Medicaid denials

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lmoore0125

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Our facility is experiencing denials from Georgia Medicaid stating 3 external cause codes are needed. However, some of these claims have diagnoses that are not required to have external cause codes or Medicaid denial is against coding guidelines. For example, we had a patient that came to the ED for a subsequent visit for a fracture. According to official coding guidelines the activity code and place of occurrence codes are ONLY reported on initial visits. Medicaid is denying stating 3 external cause codes should be reported. We are just wondering what other facilities are doing about this issue. Any advice is appreciated!
 
lmoore0125 said:
Our facility is experiencing denials from Georgia Medicaid stating 3 external cause codes are needed. However, some of these claims have diagnoses that are not required to have external cause codes or Medicaid denial is against coding guidelines. For example, we had a patient that came to the ED for a subsequent visit for a fracture. According to official coding guidelines the activity code and place of occurrence codes are ONLY reported on initial visits. Medicaid is denying stating 3 external cause codes should be reported. We are just wondering what other facilities are doing about this issue. Any advice is appreciated!
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