Wiki Help! When is this ok to change a DX after a denial?

[Crystal82603]

Hello,

I am a coder for a lab. We really don't do the coding here, its all sent to us from the provider and we code what they tell us to code. So i feel like I am losing a lot of my knowledge, and I am now second guessing myself. Please help.

-if insurance denies for a DX issue, i will call and see if they have anymore codes to add and resubmit. If none i have to take adjustment.

-Occasionally i will get a claim that will deny bc there are screening codes along with a DX code and they will not process with both, so I have been told to remove the Z codes and resubmit, is this ok to do?

-I work for a lab that does specialized testing, and I will get an order from the provider and they will list 10 plus codes with DX that do not relate to the testing done. Do I have to list all possible codes they have provided? Like acne, when we are doing testing for non related things?

Sorry. I just want to make sure this is all done correctly!

 

[pedscoder21]

The providers need education and/or they need to let the coders do the work in order to bill these labs compliantly.

For use of screening Z codes, follow ICD-10 instruction:
"Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test."

I'm willing to bet that the labs your physicians are performing are for signs/symptoms and conditions the patient has rather than to identify potential diseases in symptom-free patients?

 

[whitney1802]

Hello,

I am a coder for a lab. We really don't do the coding here, its all sent to us from the provider and we code what they tell us to code. So i feel like I am losing a lot of my knowledge, and I am now second guessing myself. Please help.

-if insurance denies for a DX issue, i will call and see if they have anymore codes to add and resubmit. If none i have to take adjustment.

-Occasionally i will get a claim that will deny bc there are screening codes along with a DX code and they will not process with both, so I have been told to remove the Z codes and resubmit, is this ok to do?

-I work for a lab that does specialized testing, and I will get an order from the provider and they will list 10 plus codes with DX that do not relate to the testing done. Do I have to list all possible codes they have provided? Like acne, when we are doing testing for non related things?

Sorry. I just want to make sure this is all done correctly!

I'll start with screening codes. If the procedure was done for a screening and nothing was found then only code the screening, do not include any signs or symptoms. If the procedure was done for let's say a colon cancer screening and a colon polyp was found then you would code the polyp and not include the screening.

If diagnosis relates to the testing done then don't code the signs and symptoms, only diagnosis. If you code from signs and symptoms then it does need to relate to the testing being done, anything not relative to testing should be excluded. Make sure you are also coding any unspecified or other specified codes last if there are other diagnoses. I think that kind of covers the resubmission and screening code issue.