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DOA One Of The Hardest Medical Billing Claims To File

DOA One Of The Hardest Medical Billing Claims To File

DOA One Of The Hardest Medical Billing Claims To File

When a patient dies en route or shortly after being admitted, coders and billers often struggle on the amount of, if any, procedures performed by the physician prior to the patient’s expiring.

Here is a good example of how to code one situation: EMS contacts the ED for CPR direction, and is directed by the ED physician pertaining to defibrillation and medications. When EMS brings the patient into the ED, the doctor examines the patient and decides there isn’t cause to continue CPR and pronounces the patient dead. On your medical billing form, you would usually bill 92950 (Cardiopulmonary resuscitation) and 99288 (Physician direction of emergency medical systems [EMS] emergency care, advanced life support) to your local Medicare carrier, and many time Medicare will reject this claim as with the notation “not necessary”.

The reason for this is, Medicare protocol usually directs that the doctor should be face to face with the patient to bill for any services rendered. The fact that the physician was directing others, no matter how qualified to perform the services, means in Medicare’s eyes, the physician didn’t actually render any services to the patient in that regard. The closest coding a physician can bill for in this situation would probably be running a code in the emergency department, even if the doctor isn’t actually performing the compressions on the patient, the fact the doctor is present and at bedside as procedures are performed make it a viable coding for your medical billing form.

Use your best judgement about the work performed and remember that basis for the coding for Medicare that the physician should be present in this situation. This will save your a lot in the way of rejected and denied claims for you Medicare medical billing claims.

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