Your pain management specialist treats a chronic pain patient but during the visit the physician fails to uncover a definitive diagnosis. Should you alter or guess a diagnosis under such circumstances?
Don’t alter or guess a diagnosis to ensure payment; instead there are codes you can choose from to get a grip on the situation.
Specificity in diagnosis coding is vital but more so because third party payers are establishing more stringent coverage criteria for therapies and procedures and are using automated edits to deny claims based on the lack of covered diagnosis.
When you use non-specific diagnosis code which is not exact, you will miss out on payment for a service rendered due to Medicare Local Coverage Decision or a third party medical policy.
Both these situations are dicey. You need to use the most specific diagnosis appropriate for the patient and make sure it’s well-documented in the medical history. Assumptions are not adequate for coding compliance. These pain management coding challenges causes missed revenue opportunities.
How do you ensure the efficiency and profitability of your pain management practice?
Attend a pain management coding conference and get pain management coding updates and answers to all your queries related to pain management coding.
Designed to maximize your coding and billing skills and increase pay-up, these conferences guide you to the most efficient, ethical way to get your claims more accurately.
In fact there’s a pain management 2010 coding update and reimbursement conference taking place in Orlando, FL later this year which you can make good use of to get more insight on pain management coding and bring more specificity to your coding.
Getting rid of all the “pains” associated with pain management coding is therefore just a conference away!
Tags: chronic pain patient, coverage criteria, definitive diagnosis, diagnosis code, management practice, medical policy, pain management specialist, party payers, revenue opportunities, specificity