Coding > Coding

Primary diagnosis not payable

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shanbull:
As long as the other diagnoses are documented and already in the claim we will bill with the order flipped. There are several diagnoses that will not be paid if listed as primary for multiple specialties. Behavioral health and acupuncture especially. This does not mean the claims themselves aren't payable and multiple insurers have told us we just need to list something else first and resubmit the claim. We end up having to do this A LOT with new providers at our clinic until they understand the rules of each insurer.

DMK:
This is completely not my specialty, but the vertigo is really the only thing a PHYSICAL THERAPIST could treat.  Not ADHD, not depression, not PTSD.  Did the primary doctor refer to P.T. for vertigo?  Then that should be the diagnosis. 

Michele:
My friend's husband was recently diagnosed as having skeletal vertigo.  I would think PT might help something like that.

PMRNC:

--- Quote ---This does not mean the claims themselves aren't payable and multiple insurers have told us we just need to list something else first and resubmit the claim. We end up having to do this A LOT with new providers at our clinic until they understand the rules of each insurer.
--- End quote ---

In my situation I was told by Aetna we could change primary diagnosis but they of course couldn't tell us it would be paid, she said to mark it as corrected claim. Going to try it. I'm still not comfortable doing it, but I documented everything and we have authorization for the visit.


--- Quote ---This is completely not my specialty, but the vertigo is really the only thing a PHYSICAL THERAPIST could treat.  Not ADHD, not depression, not PTSD.  Did the primary doctor refer to P.T. for vertigo?  Then that should be the diagnosis. 
--- End quote ---

MBiller had the PT problem.. I sort of stole the post with my ADHD dilemma which I apologize for. At time I didn't know it was PT which is why I asked for more info ;)

shanbull:

--- Quote from: PMRNC on July 03, 2014, 02:55:12 PM ---
--- Quote ---This does not mean the claims themselves aren't payable and multiple insurers have told us we just need to list something else first and resubmit the claim. We end up having to do this A LOT with new providers at our clinic until they understand the rules of each insurer.
--- End quote ---

In my situation I was told by Aetna we could change primary diagnosis but they of course couldn't tell us it would be paid, she said to mark it as corrected claim. Going to try it. I'm still not comfortable doing it, but I documented everything and we have authorization for the visit.


--- End quote ---
It does feel strange, I know. We've never run into trouble doing it though because we always make sure the documentation supports it, that really is the most important part. 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.

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