Coding > Coding

Labial Agglutination for 2year old

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Tameka79:
Dr. does a labial agglutination on a 2 year old little girl.

The patient would not be able to stand the procedure if he did not take her to the OR and put her under. She was also having urine retention because of the labial adhesions. He examined her as well while she was under. 

Can I bill an examination under anesthiesia code alone with the procedure code of 56441? If so, what would the code be? The pelvic exam under anethesia code doesn't seem appropriate.  That seems more fitting for an older patient that he could fully examine.

kristin:
Hi, Tameka79-

Quick question, are you a certified coder and the biller/billing company for this doctor's claims that you have been asking about?

Tameka79:
Hi Kristin,

I am the biller for the doctor. I am not a certified coder.

Michele:
Does the physician have a coder on staff?  As billers we all are required to understand coding but it looks like your provider is expecting you as the biller to also be the coder and that could result in problems.  You have to be careful because you will be liable if audits are done and codes are not correct. 

Do you have access to the chart/notes?  That is important when coding because the notes must support the codes billed.

With all that being said, the situation you describe is a bit unusual.  I don't know of any other codes than the pelvic exam under anesthesia for what you've described.  Your question is "can I bill.....".  You can bill anything as long as the service was provided.  Whether or not it is a covered expense is a totally separate question.  We are not at all trying to be difficult.  It is just unfortunately common for billers to get caught up in "how do I get that paid" and that can be dangerous.  Coding must be done to most accurately describe the services being performed.  Codes or modifiers cannot be used simply to get something paid.  Our job as billers is to get everything that the provider is entitled to which can cause some to switch mindsets to "how do I get that paid".  We just want to make sure you are clear on your responsibilities and liabilities. 

I hope this is helpful.  :)

Tameka79:
It does help.  Thank you very much Michelle.

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