[Ohioaap-practicemanagers] Anthem coding edits

[Michael Chamberlin]

Theresa,

We don't test for Influenza in our office, so we rarely use the dx code
Influenza.  We were having problems in the past when we would use "acute
pharyngitis" and "acute URI" for the office visit code and a strep test.
We now will link the URI code with the office visit and the acute
pharyngitis with the strep test and we have not had problems getting paid
since we made that change.

I agree that it is wrong for them to change the rules intermittently.  It
seems, at times, that they are trying to find ways to not pay us.  If you
continue to have problems, could you fill out an AAP "hassle factor" form?
Then, the AAP staff can help look into this.

Hope that helps,

Mike

-- 
Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)

On Wed, Jul 3, 2019 at 3:01 PM Theresa Vonhoene via
Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
wrote:

> Hi All,
>
>
> I was just wondering if anyone else had this issue with Anthem claims back
> in February during flu season where Anthem would not pay the office visit
> if the claim had both J02.9 (acute pharyngitis) and J11.1 (Influenza).
> This was the response we got from our Anthem rep.
>
>
> I checked in Encoder- and the dx’s that you are having the issue with
> J02.9 and J11.1 are listed as mutually exclusive and should not be coded
> together.
>
>
>
> Please see below- it is in the section notes on Encoder for the J02 dx
> range.  You will need to file corrected claims- please keep in mind that
> this edit is also scheduled to be turned back on in October, so you will
> begin to see these types of denials again if dx codes that are considered
> mutually exclusive to each other are coded on the same claim.
>
>
>
>
>
> So Anthem can turn edits on & off so they don't have to pay claims???
> Makes no sense to me.
>
>
> Would love to know if anyone else is dealing with this or did you just
> correct your claims by dropping off one of the dx codes so the claims would
> get paid.
>
>
> Thanks,
>
> Theresa
>
>
>
> Theresa Von Hoene, CPEDC
> Anderson Hills Pediatrics
> Insurance Manager
> 513.232.8100 x3043
>
>
>
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