Coding > Coding

Primary diagnosis not payable

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Michele:

--- Quote from: shanbull on July 03, 2014, 06:40:28 PM ---Certainly not a good thing to get into the habit of doing, but it works to straighten out issues where the provider just didn't know not to bill something primary or a policy was changed and we didn't receive the update quickly enough to alert the affected providers before claims started being denied.

--- End quote ---

I agree but we run into it occasionally too where the provider saw a patient for two or three diagnoses and placed them in a certain order.  Then upon realizing that the order made a big difference (to pay or not to pay!) they said that if they had known that they would have put them in a different order.  They state that their notes support it because one issue didn't stand out above the other.  We have also run into some plans that exclude coverage for ADD as well.  In one case the patient had ADHD and behavioral issues.  The provider used both dxs and services were denied.  But like Shanbull said, not good to get in the habit of changing dxs, it may get the provider flagged. 

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