You can’t justify a service with a fourth-digit diagnosis code when carriers require a more specific fifth-digit code to describe the patient’s condition.
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You will probably never like coding. But you’ll need to know the basics and be able to speak the language of coding. Why?
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By comparing the procedures that doctors perform to the largest national database describing patient care, a practice can evaluate potential miscoding of evaluation
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Only you, not a staffer, should select diagnosis codes for claims. An exception is if you have a certified professional coder on staff, and you’ve given him or her the responsibility to abstract the records.
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Reimbursement claims actually require the use of two coding systems: one that identifies the patient’s disease or physical state (the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM, codes)
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Billing for services at a level higher than the documentation supports is considered up coding. Being accused of up coding is mortifying, especially when it is not intended.
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Even if you are meticulous in your coding, you still might miss the one Medicare document that says you can’t do a particular thing,” says Pittsburgh attorney William Maruca, chair of the American Health Lawyers Association’s group on fraud and abuse.
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Modifiers may be used to indicate to the recipient of a report that:
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Modifiers may be used to indicate to the recipient of a report that:
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If you have certified professional coders on staff, and you’ve given them the responsibility to abstract the records, make sure they don’t assume a diagnosis based on your specific treatment or prescription.
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