Wiki ED Diagnosis Code

[rlcohen76]

Anyone hear of an Insurance company denying claims with the reason "“This diagnosis does not support the existence of an emergency condition…”
We are seeing a pattern developing for Dx code 462 Acute Pharyngitis on the ED physician side.
For one patient this was the only diagnosis code and for another patient they presented with An Upper Respiratory Infection as well.
Any help/insight would be greatly appreciated!!! Thanks!

 

[ahinman]

Yes, I have actually heard of an insurance company denying for DX. Unfortunately, the ones that we have had there is nothing we can do with. In the patient's insurance policy it states some of the things that are not considered as an emergency. I do the coding and do not really have much to do with the billing part of our claims but I think that these go back to patient responsibility.