The situation: A pain management specialist treats a chronic pain patient. During a visit your physician isn’t able to uncover a definitive diagnosis. Here you shouldn’t do a guess work. Doing so may land you in a spot. Assumption is something which you should certainly stay away from in such situations.
Specificity in diagnosis coding is very important. 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 a covered diagnosis.
Using non-specific diagnosis code, which may be close but not exact, may mean you will not be paid for a service due to Medicare Local Coverage Decision (LCD) or a third-party medical policy. Or it may mean you are paid in error for a service for which there would be no coverage if you had used the right diagnosis.
Both of these scenarios are problematic. To learn how to use the most specific diagnosis appropriate for the patient and ensure it is well-documented in the medical record, you can attend pain management coding seminars and conferences.
When you attend one, you’ll learn to be more specific in your pain management coding, helping you maximize your skill-set, reduce claim denials and receive the reimbursement you deserve.
In fact, come December and Orlando, FL will play host to a pain management 2010 coding update and reimbursement conference. So put off all your things for a later date and be right there for all the coding action. You stand to take home a lot of pain management coding know how from this conference.
Tags: chronic pain patient, claim denials, coverage criteria, definitive diagnosis, diagnosis code, medical policy, medical record, pain management specialist, party payers, specificity