Forum - Questions & Answers
Diagnosis coding
Does the diagnosis used affect the amount of reimbursement you receive. I always thougt the diagnosis determined if you got paid but not how much you got paid.
paid
You get paid on the HCPCS (CPT or Level II)--you get denied on diagnosis codes. Diagnosis codes establish medical necessity, not how much you get paid.
Diagnosis Coding
Diagnosis coding only affects hospital inpatient reimbursement & must be properly sequenced by the coder.
but...
the insurers look to match the diagnosis and CPT to see if they are "compatible". So a 99215 - level 5 established pt office visit with a 462 - sore throat - would raise a flag and could lead to an audit.