Your interventional radiologist may be tending to more patients complaining of chronic pain. Trouble crops up when you do not see documentation of a definitive diagnosis for the visit. You know better than to change or guess a diagnosis to seal payment. Here are some appropriate codes that could help you handle the situation.
Understand why specificity matters
Specificity in diagnosis coding is always key, 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 reject claims based on the lack of a covered diagnosis.
Reporting a non-specific diagnosis code which may be close but not exact may mean you will not be paid for a service due to a Medicare LCD or a third-party medical policy. Opting for less specific codes might also mean you receive payment for a service that would not be covered under the right diagnosis.
Both these situations present different challenges. Using the most specific diagnosis for the patient and ensuring it is well documented in the medical record will help ensure the right reimbursement for the provider and appropriate coverage for the patient.
Reality check: Using the wrong diagnosis may limit coverage or may get you paid for services that are not covered, which increases your risk during audit.
For more ICD coding tips, sign up for a one-stop medical coding website. Such a site comes with official descriptors and guidelines for ICD 9 codes and also provides you the latest on the ICD 9 codes.