Specificity In Diagnosis Coding Is Important In Icd-9 Codes
Your interventional radiologist may be tending to more patients complaining of chronic pain
. Trouble crops up when you don't see documentation of a definitive diagnosis for the visit. You should know the appropriate codes that can help you handle the situation:
Why specificity in diagnosis coding matters
Specificity in diagnosis coding is always important; however it's increasingly vital as third party payers are establishing more stringent coverage criteria for therapies and procedures and are using automated edits to deny claims based on the lack of a covered diagnosis.
Using a non-specific diagnosis code which may be 'close' however not exact may mean you won't be paid for a service due to a Medicare LCD or a third-party medical policy. If you opt for non-specific codes, it might also mean you receive payment for a service that would not be covered under the right diagnosis.
Both these situations come up with different problems. Making use of the most specific diagnosis for the patient and ensuring it's well documented in the medical record will help ensure the right reimbursement for the provider and appropriate coverage for the patient.
The reality is: Using the wrong diagnosis may limit coverage or may get you paid for the services that are not covered, which increases your risk during audit.
For more on this, sign up for a one-stop Medical Coding website. Onboard such a site, you can get all the just-in ICD-9-codes under one roof. Pretty soon, you'll realize that staying tuned to the ICD-9-Changes is an easy thing.