mrsrobinson525
Contributor
I'm a newer coder and I work for a smaller private practice. I normally review charges, but recently I've been asked to help with denials.
Our providers code their own charts and we have a lot of lab denials. I'm hoping someone can give me some information and references I can provide to my management team.
If a lab was denied for non-covered diagnosis:
-I've been told to check to see if there is another covered diagnosis listed in the chart note, and if so, rebill with this diagnosis.
-If there are no covered diagnosis codes in the chart note, I've been told to check the patient's problem list, and if I find one, ask the provider to add a late entry/correction for that code.
-If nothing is covered in the patient's chart or problem list, I've been told to send back the CMS approved diagnosis list to see if the provider can find anything that is appropriate for the patient.
If they find a diagnosis, the provider would add a late entry/ correction to the chart note and we would rebill with this.
Is this process correct?
The first two steps seem reasonable, but I don't know about sending the approved diagnosis list. This seems like we are changing the diagnosis to "get paid".
Can someone please give me references? I don’t want to do anything incorrectly and jeopardize my accreditation.
Thanks so much!
Our providers code their own charts and we have a lot of lab denials. I'm hoping someone can give me some information and references I can provide to my management team.
If a lab was denied for non-covered diagnosis:
-I've been told to check to see if there is another covered diagnosis listed in the chart note, and if so, rebill with this diagnosis.
-If there are no covered diagnosis codes in the chart note, I've been told to check the patient's problem list, and if I find one, ask the provider to add a late entry/correction for that code.
-If nothing is covered in the patient's chart or problem list, I've been told to send back the CMS approved diagnosis list to see if the provider can find anything that is appropriate for the patient.
If they find a diagnosis, the provider would add a late entry/ correction to the chart note and we would rebill with this.
Is this process correct?
The first two steps seem reasonable, but I don't know about sending the approved diagnosis list. This seems like we are changing the diagnosis to "get paid".
Can someone please give me references? I don’t want to do anything incorrectly and jeopardize my accreditation.
Thanks so much!