Monday, June 14, 2010

Claim denied as Invalid diagnosis code


    The following types of rejections are possible; Diagnose code does not match with the procedure code (check in LMRP). The Diagnose code reported on the claim is not to the highest level of specificity. Diagnose code is no longer valid.  

    Action: Check the charge sheet as to whether the rejection is due to wrong keying in at the time of charge entry, if yes, Go ahead and change the correct Diagnosis.  If no, it may be because of incorrect Diagnose code. It is possible that the 4 digit Diagnose code used is not the highest level of specificity and the carrier wants a five digit Diagnose code. Coders will also have to recheck to see if the diagnosis code used has been deleted, if it matches with the procedure code and if it is of the highest level of specificity and if not find the right diagnosis code, correct it and refile the claim.

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