Can You Choose the Correct Medical Billing Pain Code?

Can You Choose the Correct Medical Billing Pain Code?

Finding the right pain code can be a sticky situation in medical billing. When dental issues come into the picture, sometimes the medical billing staff members go crazy. Knowing how to simply break down a chief complaint in any situation is a medical billing skill everyone should master.

If a patient comes into the emergency department and complains of a dental wire sticking into his/her lip, you already have your chief complaint. Even if your physician does not treat the patient but merely advises him/her to check with the dentist and buy someone wax from the local drugstore, you can still do medical billing for this service. Whether you get medical billing reimbursement or not is determined by your code selection.

You would not use the diagnosis , “Dental hardware pain”. since the hardware itself is not in pain, you would use lip or mouth pain . Then, since it is for mouth hardware, you could use follow-up medical billing codes such as post procedural complication codes or an E code.

Many medical billing staff members get worried whenever dealing with dental issues. Perhaps this is because many insurance companies fly red flags when the mouth is part of a diagnosis or treatment plan. Don’t let this bother your practice. Medical billing is meant to be accurate and honest. This means you should accurately only document the diagnosis and treatment your physician uses. If this means extra documentation and explanation is needed for medical billing reimbursement, so be it.

To prevent a prolonged medical billing process, send in documents with your claim. This will prevent the lag time of the payer requesting documentation and the provider submitting it. Medical billing records submitted with the claim will save your practice time and money.

View all Articles by: Melissa Clark, CCS-P