nyyankees
True Blue
I was curious. Does anyone put E codes on all their physician office based encounters - when applicable?
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Wiki E Codes -office based encounters
- Thread starter nyyankees
- Start date
mitchellde
True Blue
Yes always when it is applicable.
klebart123
Contributor
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To E or not to E
You'll find that a lot of insurance companies don't like E-codes, and won't cover a claim with them on it. However, I love them, and they are proper coding. Just never assign them as the primary diagnosis.
You'll find that a lot of insurance companies don't like E-codes, and won't cover a claim with them on it. However, I love them, and they are proper coding. Just never assign them as the primary diagnosis.
mitchellde
True Blue
If the payer does not pay a claim with E codes then they are not paying the claim due to liability not because of an E code. The E codes help to define who is responsible for the injury. When they payer can see from the E code that this is a third party liability then they will in some cases deny the claim. Sometimes the place of the injury is just as important as the code for how the injury happened. These are appropriate denials. It is musch better to have this denial up front so that you can discuss this with the patient, if there is a third party liable then you can decide how to procedure with the payment, either call the liable party or have the patient turn the claim in to their attorney. IF you do not append the E code and the claim pays and say a couple of years go by, the payer on a post audit decides this was a third party liablity and they should not have paid the claim and they request a refund. Now you need to find the patient and request payment, perhaps the patient has already settled the lawsuit, and furthermore has already spent all the money, this will be a tough payment to obtain now.
So in my mind E codes do NOT make a claim fail, they allow a claim to process correctly.
Also they always are secondary codes never first.
So in my mind E codes do NOT make a claim fail, they allow a claim to process correctly.
Also they always are secondary codes never first.
mitchellde
True Blue
That is not HIPAA compliant . The regs state all HIPAA entities which does include tri care must use vol 1 and 2 of the code set and must follow the guidelines. There are no exceptions. The V and E codes are chapters in the required code set they cannot not recognize these codes
RebeccaWoodward*
True Blue
I have to admit, I haven't heard of a carrier not accepting "E" or "V" codes. The link below indicates that Tricare does accept "V" codes.
"For V codes providing descriptive information as the reason for the patient encounter, designate that as the primary diagnosis. An example of a descriptive V code is a routine infant or child health visit, which is designated as V20.2"
http://www.humana-military.com/library/pdf/claims.pdf
"For V codes providing descriptive information as the reason for the patient encounter, designate that as the primary diagnosis. An example of a descriptive V code is a routine infant or child health visit, which is designated as V20.2"
http://www.humana-military.com/library/pdf/claims.pdf