Wiki ER Facility Billing

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afryberger

Networker
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Lebanon, PA
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I have never done facility billing; only professional. They asked for help with ED denials for diagnosis. I'm not sure what I am missing. The denials are all stating "Invalid patient RSN for visit. Missing or invalid information". The DX codes are valid so I feel I am missing something that is needed for facility billing. Any guidance would be greatly appreciated.
 
afryberger said:
I have never done facility billing; only professional. They asked for help with ED denials for diagnosis. I'm not sure what I am missing. The denials are all stating "Invalid patient RSN for visit. Missing or invalid information". The DX codes are valid so I feel I am missing something that is needed for facility billing. Any guidance would be greatly appreciated.
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Can you give an example of the diagnosis codes? Are there excludes conflicts or anything like that?

I have worked hospital billing in the past - for the facility ER vs the ER physician charge, the diagnosis coding isn't substantially different.

There are differences in how the ER level is determined and fields that get filled out on a UB-04 that aren't on a CMS-1500 form, etc. But the diagnosis coding are reasonably consistent between both settings.
 
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Afryberger,
There are lots of unspecify disease dx code ending in numbers 90 .Payers want more specific details do not like so much unspecify dx codes. Hopefully the provider has listed it in documentation the details or stages of disease. Also some disease have differ stages or need another dx code to be accurate. There are stages of disease in N18, E11, J01, I69, J32, Cancers, Neoplasms, F02, G47, F32, Etc. Also some disease want added dx .such as UTI or dx N39 want bacteria listed or additional dx code. If injury add how and where it happened, incident, and date it happened on claim from documentation.
I hope helped you some what
Lady T
 
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Is it a RT/LT/bilateral/unspecified issue?
Is it a non-specific dx code?
Did the visit include a procedure which has a modifier RT/LT/50 but the diagnosis is not matching?
Other than that, as Susan said, we need some examples because there could be other things going on.
 
afryberger said:
Two Examples:
S00.03XA & W19.XXXA
S92.211A, S82.52XA & W19.XXA
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I wonder if that payer doesn't like that Unspecified Fall code (W19.XXXA), since it seems to be a common denominator in those examples.

Are you seeing any other claims where the payer IS paying it?
 
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