by Pat Scheer, Quality Operations Manager
Health Care Providers have an important role to play in assuring that their patients are correctly identified as having certain diagnoses or treatments. With the growth of direct outreach to patients for disease management activities, the increasing accountability of health plans to HEDIS specifications, and the wider use of electronic medical record systems in primary care, accurate ICD-9 coding is imperative. Coding is also being used in calculating pay-for-performance measures.
When coding any encounter for health care, be sure your billing service knows how to assign current and correct codes for:
- the reason for an office visit
- any presenting symptoms
- any current numerical codes for diagnosis
- screening or history using V codes.
Tests ordered for rule-out purposes should be coded for the symptom rather than the diagnosis to be ruled out. Health plans are dependent on medical offices as well as radiology and laboratory services to provide correct coding so that patients’ records reflect accurate diagnoses. Physicians and patients may receive information from their health plans about certain conditions that are coded in their claims or medical records. Our goal is to send educational information to the right patient regarding the right condition in a timely manner. We appreciate your efforts to help us.
