Wiki Incentives for billing certain diagnoses?

[bungalowgirl]

does anyone know if medicare (or any of the large payers) reimburses physicians MORE for billing certain diagnoses over others (ie: type 1 diabetes complications vs type 2 diabetic complications)? Or do other financial incentives exist for billing one type vs the other?

 

[bink1018]

reimbursement

Hello,

Reimbursement in the physician office is driven by CPT code, not ICD code. Please also be aware that we code according to the documentation provided.

If you are referring to incentive programs like STARs measures or HCC/Notable Code capture, they also depend on the documentation. If the documentation does not support a higher level code (250.62), we are required to use the lower level code (250.00) as supported by documentation.

Work with your physician to improve their documentation if you find yourself coding to less specific codes due to lack of documentation.

I hope this answered your question.