We have a 2 1/2 yo patient we are treating for hypotonia. Insurance won't pay the 781.3 dx, they need a medical dx. He has pulmonary hypertension and a heart defect. This is not something we typically see, can I use the pulmonary hypertension as a payable medical dx for pt? Child also has autism and that is not a payable dx as well.
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Wiki Pediatric Physical Therapy DX
- Thread starter kbegin
- Start date
mitchellde
True Blue
for ICD-9 Cm per the guidelines for code assignment, # 15 in the general guidelines section --encounter for rehabilitation... you are to use the V57.- code for encounters for rehab as the first ;listed dx code. V57 codes are first listed only allowed. You code second as the reason for rehab which is the hypotonia. At npo time is it appropriate to use a dx code for a diagnosis not treated nor the reason for the encounter. If the claim is denied then perhaps the rehab benefits are used up or do not exist for this patient. The payer (other than WC) cannot deny the claim because you use a V code first listed.
mitchellde
True Blue
I understand, however you are required to use the V57 dx code first and then the 783.- code secondary as the reason for the treatment. The payer is simply communicating a type of dx that is considered payable. You can use only what the documentation and the guidelines allow and require. If the patient has rehab benefits then the V57 code should work as that is the code that indicates the reason for the encounter is rehab