Author Topic: 760.71  (Read 2617 times)

Anne

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760.71
« on: April 02, 2010, 11:35:47 AM »
760.71 is for newborns (fetal alcohol syndrome) but what is code when child is 10 yrs old?

blhoffman

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Re: 760.71
« Reply #1 on: April 02, 2010, 02:00:45 PM »
HI Anne,

I've researched this and could not find an age restriction associated with this diagnosis. One insurer reported they received this diagnosis on patient's from age 0 - 21.

Maybe someone else will have another opinion. Good luck!

Brenda

oneround

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Re: 760.71
« Reply #2 on: April 02, 2010, 03:38:38 PM »
Talked to one of our UM nurses on this.  FAS is mainly determined at TOB due mainly to the flattened/Broaden facial features.  As this is a 10 year old how is the doc making this determination of FAS? is the Dr. stating FAS based upon documentaton in the pt's maternal chart?  What is the CC on your patient?  Is the MD stating the CC is a late effect of FAS.  Could you be a little more specific.
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

Anne

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Re: 760.71
« Reply #3 on: April 02, 2010, 11:52:45 PM »
yes, it's a late affect of FAS.  I'm actually billing for speech therapy and this is the ICD9 she gave me, which she got from patients referring MD.  Child is a medicaid patient and this code was paid last claim, but when I used it again, it was denied saying "not appropriate for age of patient"

Michele

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Re: 760.71
« Reply #4 on: April 04, 2010, 08:50:11 PM »
Wow this is tough.  I don't show an age restriction on the 760.71 either, but they are denying it.  I couldn't find any other FAS dx for an older child.  Is the FAS the only dx for the speech therapy?

Michele
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blhoffman

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Re: 760.71
« Reply #5 on: April 04, 2010, 10:48:18 PM »
I'm from PA and deal with PA Medicaid through out the day. I find that when I call with the claim number the reps. are really good at finding the problem and explaining to me why my claim is denying. If it is me or them.

They always call me back within the time frame they give me also. In my opinion, for what is worth, just call them and ask them why. They should research it and help you out. If you have a claim number for the claim that did pay, that is even better.

 


oneround

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Re: 760.71
« Reply #6 on: April 05, 2010, 01:35:14 AM »
I would also push the guidelines for late effects, section 1.B-12.  You code the residual first then the late effect.  As stated in the guidelines, late effects can occur MONTHS or even YEARS later. Also, make sure that the carrier is not trying to classify FAS as Acute because if they ae that may be the probelm   The ladies are correct there is no age restriction indicated, but the general rule is that FAS is determined at TOB because you can't determine the dx months or even years later.  I would make that call first as the ladies reccomend and if all else fails appeal with documentation and a copy of he late effect guidelines.  Nowdays , most all claims are pd automatically, no processor involved, the DX could be hitting an age restriction system edit which simply requires processor intervention.  You may also need the pt's maternal chart, diagnosing FAS, to support your appeal.  I'm going to run a mock scenario through our 3M system tomorow and see what edits I get.  I agee with Michelle, ths is a tough one to call.  Question, when you are billing are you linking both dx's to your CPT codes?  Just a thought
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

Anne

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Re: 760.71
« Reply #7 on: April 05, 2010, 10:54:18 AM »
thanks for all input.  I'm wondering if Medicaid is adding in more ways to suspend or deny claims that they used to auto. pay before, because I have several problems now that never had before.  We DO send in lots of documentation before billing, just to get authorization, but once auth is in place, it wasn't much of a problem getting payment, but now I have WAY more appeals, modifiers required, and some I do not know WHAT they are wanting.  It's getting worrisome.