Wiki Inpatient foster care placement

[colebean76]

We have a patient that has been admitted for 33 days for foster care placement. Patient has a history of heart and lung transplant in 2016, a history of rejection of that transplant, and diabetes. Pt has no current health issues due to these conditions (diabetes is well controlled), is simply here for foster care placement. We are struggling with what the PDX should be in this scenario. All of the documentation lists the PDX as "Foster care placement". A lot of the codes fitting this that the coder has found cannot be PDX. Just wondering if anyone else has encountered this issue and how you went about determining the PDX. Thanks in advance!!

 

[CBLENNIE]

Who are you trying to bill for these services? Medicaid or commercial insurance?

 

[colebean76]

Who are you trying to bill for these services? Medicaid or commercial insurance?

Great question, not sure. Lets assume Medicaid for the time being until I find out otherwise.

 

[CBLENNIE]

Are you looking for what revenue code to bill for the R&B or are you asking about procedure codes for professional services such as physician visits?

Also, what state are you in because if you are assuming the payer is Medicaid at this point it is going to be dependent on what the state's Medicaid program requires for billing the services you are trying to bill for.

 

[colebean76]

State is Ohio, and we are trying to determine the PDX (primary diagnosis) for the inpatient stay. The physician simply keeps saying they are waiting for "foster care placement".

 

[Angela87Camille]

hi, I am a student, and haven't a clue has how to help, sorry, but this case sounds interesting to me. So you're in Ohio and a pt was admitted to a hospital without any medical issues? maybe something within your state guidelines that explains when insurance would cover this situation?

 

[xXxPARAGONxXx]

We have a patient that has been admitted for 33 days for foster care placement. Patient has a history of heart and lung transplant in 2016, a history of rejection of that transplant, and diabetes. Pt has no current health issues due to these conditions (diabetes is well controlled), is simply here for foster care placement. We are struggling with what the PDX should be in this scenario. All of the documentation lists the PDX as "Foster care placement". A lot of the codes fitting this that the coder has found cannot be PDX. Just wondering if anyone else has encountered this issue and how you went about determining the PDX. Thanks in advance!!

Very interesting. Perhaps you can query the social worker, or are you the social worker?

 

[colebean76]

Very interesting. Perhaps you can query the social worker, or are you the social worker?

I am an inpatient coder. This case is one of my fellow coders who is stumped on what the PDX should be. I figured I would try here to see if anyone else has come across this scenario before.

 

[colebean76]

hi, I am a student, and haven't a clue has how to help, sorry, but this case sounds interesting to me. So you're in Ohio and a pt was admitted to a hospital without any medical issues? maybe something within your state guidelines that explains when insurance would cover this situation?

There are no CURRENT health issues, but with the history of transplant, and DM, the patient has chronic health issues that would need regular follow up.