Wiki Newborn & Medicaid Question

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Adrianne02

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I work for an emergency transportation company and our claims are being denied by Texas Medicaid because the diagnosis codes do not fall under their Emergency Medical Condition Codes. My problem is that we transport newborns and there are no perinatal period or congenital anomaly codes on the listing.

Can I use a regular code (not one from the perinatal period) to use instead? Is there a rule or something that legally states I have to use a newborn code? I read the guidelines in the beginning of the ICD-9-CM book and it does not state you are obligated to use a newborn code. If you know any link or website that can help me clarify that would be great!
 
Can you give an example?

Can you give us an example of the codes on the approved Emergency Medical Condition list? I'm not sure what you mean by needing to be perinatal or congenital anomaly codes.

What codes are you using?

For example is HLHS 746.7 listed? If not what are the signs / symptoms that might apply ... cyanosis? SOB? resp distress?

Maybe you just need more specific diagnoses coding?

F Tessa Bartels, CPC, CEMC
 
There are no newborn or congenital anomaly codes on the listing at all.

The website is:
http://www.tmhp.com/File Library/File Library/Bulletins/Medicaid/2008/218_M.pdf

It starts on page 41 and ends on page 45. Those are only the approved codes we can use and they don't include those sections so I'm very limited. They will only pay what is on the listing otherwise every newborn transport will have to be appealed.

When using cyanosis (782.5) it excludes newborn (770.83) which is not on the list and as for SOB (786.05) the newborn code is (770.89) which is also not on the list. Can I use SOB (786.05) instead of 770.83? Is there a rule that says I have to only use a newborn code since the baby is under 28 days old?
 
Contact Texas Medicaid

I would contact your Texas Medicaid claims processing office for assistance. My gut reaction would be to go ahead and use the codes for the symptoms (cyanosis, SOB) that are NOT specific to newborns, even though you are transporting a newborn.

You might also want to go to your state legislator with this issue and ask him/her to get Texas Medicaid to update their diagnosis list to include the specific codes for newborns. (I know ... Wisconsin's Medicaid CPT list was last updated Dec 2005!)

F Tessa Bartels, CPC, CEMC
 
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