Anesthesia Conferences: Do Away With Diagnosis-based Denials

By Author: Julia Rose
Total Articles: 89
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Establishing medical necessity for your anesthesiologist's services can be one of the toughest coding challenges what with payers tightening the reins on reimbursement.


Here are some practical tips for choosing the best diagnosis to establish the need for anesthesia so that your reimbursement remains intact.


Study the patient's circumstances. Medicare defines medical necessity as services reasonable or necessary to diagnose or treat an illness or injury, or to improve the functioning of a malformed body member. Payers consider each case individually to determine if the treatment method is reasonable and necessary.


Match the diagnosis and procedure. Some payers have lists of approved diagnoses for procedures and those lists can be extensive. If you submit a procedure that isn't on the payer's list can send your claim straight to denial.


Check ICD-9's symbols. The colorful dots, triangles and other symbols in ICD-9 instruct you how to report certain diagnoses correctly. One needs to pay attention to the symbol or mark that defines ‘not first-listed ...
... diagnosis'. You'll find this designation on codes like 357.2 (polyneuropathy in diabetes).


You need to watch out for some coding mistakes which can be a slip of the finger. If you encounter a diagnosis-based denial, double-check your claim against the physician's record. Even if you intended to submit the correct code, you might have filed a claim with a typo. If the diagnosis you submitted was correct, but did not figure on the payer's approved list, talk with your physician. A secondary diagnosis documented by him might work just as well and turn the denial into acceptance. For more tips for choosing the right diagnoses to establish the need for anesthesia, medical coding seminars or anesthesia conferences are very helpful. But in case there's no conference happening in the recent future, audio recordings in CDs and MP3s of recent conferences will certainly be of great help to you.


Gain knowledge about medical coding by attending proper medical coding conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.