Medical Billing Forum

Coding => Coding => Topic started by: MJ on November 18, 2010, 01:03:13 PM

Title: Specified coding
Post by: MJ on November 18, 2010, 01:03:13 PM
Are there any financial reimbursement advantages for using specified codes versus unspecified?
Title: Re: Specified coding
Post by: Michele on November 18, 2010, 02:41:45 PM
MJ,

    Not sure what you mean.  Are you referring to unlisted procedure codes?

Michele
Title: Re: Specified coding
Post by: MJ on November 18, 2010, 03:37:26 PM
No.  I'm referring to diagnosis codes.  For instance, abdominal pain.  If a unspecified site is used, 789.00, vs. a specified site, 789.02,  Do insurances ever deny a claim because the code is unspecified or pay at a lower reimbursement? 
Title: Re: Specified coding
Post by: Michele on November 19, 2010, 01:28:49 PM
I have never seen claims reimbursed lower due to dx codes.  However, some carriers will deny claims if the dx isn't specific enough.

Michele
Title: Re: Specified coding
Post by: tlewis on January 20, 2011, 05:54:13 PM
A claim generally is denied or paid. unless a modifier 52 (reduced service) is used. Do you have any examples of CPT with certian ICD-9 codes that are getting denied? I would check and find out what LCD the code is under and cross reference it on the cms website. Also in oregon OHP (oregon health plan) has the code sets available online so you can check to see if the code is payable with the diagnosis.