Forum - Questions & Answers

May 26th, 2010 - rphelps 615  1 

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.

May 26th, 2010 - nmaguire   2,606 

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.

May 26th, 2010 - dsteed   141 

Diagnosis Coding

Diagnosis coding only affects hospital inpatient reimbursement & must be properly sequenced by the coder.

May 26th, 2010 -

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.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association