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Coding tip: Follow an appropriate diagnosis coding process

Ambulatory Surgery Reimbursement Update, June 12, 2007

Have you ever experienced a "medical necessity" claim denial? Medicare and other payers frequently deny claims for this reason, but it doesn't mean you should not have performed the procedure. Rather, it usually means there is a problem with the diagnosis code(s) you billed.

Always list the first diagnosis code as the chief reason for the surgery or services you provided. List subsequent diagnosis codes in descending order of importance.

When performing multiple procedures, make sure to link the correct diagnosis code related to each procedure billed. Observe the diagnosis list on Medicare Medical Review Policies when necessary.

Using unspecified diagnosis codes and other general terms is discouraged, as they do not clarify the medical necessity of the procedure performed.

Terms that may indicate an unspecified diagnosis include "NEC" and "NOS" in your ICD-9-CM book.

This tip is brought to you by Ellis Medical Consulting, Inc.

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