Karen325
New
I have a claim that was given a denial code of "not covered under the patients plan" and it was an office consult with a diagnosis of obesity. The patient was being seen for a consult on interest in a bariatric surgery so of course this probably was not covered considering this consult was for a cosmetic procedure. However, most bariatric eligible patients do have other diagnoses that come along with obesity such as diabetes, sleep apnea, reflux, joint pain, etc... So if those things are also mentioned in the patients consult is it wrong (or fraudulant) to make one of other diagnosis the primary diagnosis and rebill the claim as corrected with the insurance carriers form of appeal in order to hope the consult gets paid for the patient?
I have the same question when it comes to colonoscopies. Patient presents for screening initially but when the scope is done they encounter a polyp which is removed. Can it still be coded as V76.51 primary and 211.3 secondary? Or the patient states they have had some rectal bleeding, or gi symptom and wanted to be checked in a screening...can a screening code
V76.51 be primary along with other codes as long as all codes are supported in the dictation?
I appreciate any input on both situations, some people tell me it's considered fraudulant to make these changes after a denial just to get payment and I have thought if it's written down and the changes are supported by dictation than why can't I change them.
I have the same question when it comes to colonoscopies. Patient presents for screening initially but when the scope is done they encounter a polyp which is removed. Can it still be coded as V76.51 primary and 211.3 secondary? Or the patient states they have had some rectal bleeding, or gi symptom and wanted to be checked in a screening...can a screening code
V76.51 be primary along with other codes as long as all codes are supported in the dictation?
I appreciate any input on both situations, some people tell me it's considered fraudulant to make these changes after a denial just to get payment and I have thought if it's written down and the changes are supported by dictation than why can't I change them.