svms
Networker
Hi,
My question is I have a claim that denied for medical necessity?
The diagnosis the Dr. used is 716.96 (knee arthritis)-an unspecified arthritis code; but the only covered diagnosis is 715.16, 715.36, 715.96 (Osteoarthrosis-knee) which is a more specific code.
Would it be okay to query the Dr. and have him addend the office note if his documentation substantiates a covered diagnosis, OR IS THIS FRAUD?
I am not exactly sure what the definition of fraud is with a diagnosis change and don't want to get myself in trouble here.
Also, can someone lead me to a link that tells me when we can change a diagnosis and when it is not allowed.
Thanks
My question is I have a claim that denied for medical necessity?
The diagnosis the Dr. used is 716.96 (knee arthritis)-an unspecified arthritis code; but the only covered diagnosis is 715.16, 715.36, 715.96 (Osteoarthrosis-knee) which is a more specific code.
Would it be okay to query the Dr. and have him addend the office note if his documentation substantiates a covered diagnosis, OR IS THIS FRAUD?
I am not exactly sure what the definition of fraud is with a diagnosis change and don't want to get myself in trouble here.
Also, can someone lead me to a link that tells me when we can change a diagnosis and when it is not allowed.
Thanks