This is a must-read misstep. Don’t settle for incorrect diagnosis to procedure mapping. Taking time to closely review documentation and make educated choices is a coder’s responsibility.
Misstep 6: Having Wrong Diagnosis to Procedure Mapping
A fast way to increase claim denials is to have a wrong diagnosis to procedure correlation. For example, if a patient has a laceration, you shouldn’t pair that procedure with a diagnosis of acute asthma. Procedures should correspond directly with the diagnosis of the patient, and be considered “reasonable and necessary” for treatment or preventative care.
It’s a coder’s responsibility to map the correct procedures with the relevant diagnosis code as documented. Knowing payer limitations and requirements (which change frequently) is essential to receive correct reimbursement—such as using NCDs or LCDs for Medicare patients.
Advice: Look at the correlation between diagnoses and procedures at your urgent care. Do they line up? Make a list of the top diagnoses in your clinic and corresponding procedures to help educate your billers. Always know your payer’s requirements before claim submission. Utilize an automated coding tool to assign common diagnoses and procedure pairings.
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