Wiki Not a coder, can I change dx on claim

[kendrarenae1013@gmail.com]

I’m not a coder. When a lab claim denies for diagnosis my employer has asked that we see if there is another diagnosis on the lab order and/or the office visit tied to the lab order. If there is another diagnosis we are told to update the claim with that diagnosis. Are we allowed to do this even though we are not coders? Are we allowed to add modifiers?

 

[perubuzz]

My, opinion is below.
Yes, ONLY if documented in chart for that date of service. DX usually come from ordering physician is ordering lab. Again, modifier can only be used if documented.
Hope this helps.

 

[csperoni]

Coders are not licensed - they may be certified. There are no legal rules about what a coder or medical biller may perform regarding your example. Each employer decides what someone with a particular job title or certification may or may not perform. There are employers that will not permit a certified coder to change a diagnosis code without clinician involvement. And there are employers allowing noncertified employees to perform all coding activities.
For your specific example, I agree with @perubuzz . IF the records already list another diagnosis on the order, I would have no issue with updating. Regarding modifiers, it would depend to me on the skill set of the employee, and the modifier being added. Modifiers like -LT, -RT, -GY, -93, -95 are straightforward and do not require any special knowledge. Modifiers like -22, -XU, -24 may require at least some baseline knowledge of coding guidelines.