Question regarding fraud or abuse

There was a patient who came in to our office and we billed a 99214(office visit) and 99406(counseling for stopping smoking). The doctor listed these diagnoses in this order tobacco abuse, dermatitis, chronic back pain, hypertension, edema, and osteoarthritis. So when the coder coded it, she listed tobacco abuse as the primary diagnosis just as the dr listed it. Well it turns out that the code 305.1(tobacco use) is an exclusion under the patients insurance plan so they denied the 99214. My question is, can I take off the diagnosis of smoking cesation and resubmit the claim so they pay the 99214 since there were other problems addressed? Or would this be considered fraudulent or abuse? I wasnt sure if this would be considered making changes to a claim just to get it paid? There are situations like this that happen all the time. Can you give me any clarification on this matter?

Mar 27th, 2013 - bsergi 110

re: Question regarding fraud or abuse

If other issues were significant code 99214-25. Odd that 99406 was the code not denied for the tobacco use. I would not remove if anything maybe change the diag order.

Mar 28th, 2013 - Codapedia Editor 1,399

re: Question regarding fraud or abuse

Can you send a copy of the note to appeal? that would clearly show all of the problems addressed.