Radiology Coding: Specificity In Diagnosis Coding Is Key

By Author: Angela Martin
Total Articles: 206
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Your interventional radiologist may be treating more patients complaining of chronic pain. Trouble surfaces when you do not see documentation of a definitive diagnosis for the visit. You know better than to alter or guess a diagnosis is to ensure payment; now learn about proper codes that can help you handle the situation.


Specificity matters a lot in diagnosis coding


Specificity in diagnosis coding is always very important; however it's increasingly important as third party payers are establishing more stringent coverage criteria for therapies and procedures and are using automated edits to reject claims based on the lack of a covered diagnosis.


Using a non-specific diagnosis code may be 'close' - however not exact - may mean you will not be paid for a service due to a Medicare Local Coverage Determination (LCD) or a third-party medical policy. Using less specific codes might also mean you get payment for a service that would not be covered under the proper diagnosis.


Using the most specific and appropriate diagnosis for the patient and ensuring ...
... it is well documented in the medical record will help ensure proper reimbursement for the provider and appropriate coverage for the patient.


Reality: Using the wrong diagnosis may limit coverage or may get you paid for services that are not covered, which increases your risk during audit. Here are some tips you can keep in mind to help ensure you get the right reimbursements:


Tackle vague TPI diagnosis
Watch for documented connection to prior problem
Dig deeper for comprehensive diagnosis
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