- #WHAT IS ANOTHER WORD FOR DIAGNOSTIC FULL#
- #WHAT IS ANOTHER WORD FOR DIAGNOSTIC CODE#
- #WHAT IS ANOTHER WORD FOR DIAGNOSTIC PROFESSIONAL#
#WHAT IS ANOTHER WORD FOR DIAGNOSTIC CODE#
Besides pointers what other limitations are present on Diagnosis Code Submission? A doctor who did a proper, comprehensive E&M for a patient would almost certainly have the information ignored when processing. This means that if HEDIS or Revenue only used the codes that were pointed to, codes that are crucial to HEDIS measures or HCC calculations would be dropped. Pointers are limited to 4 or less per line and average around 1.3 per line. Why should HEDIS, Medicare Revenue efforts or the new Health Insurance Exchange ignore Diagnosis Pointers? In the off chance other diagnosis are relevant to the treatment, they are still available to the examiner at the insurance company who is doing the adjudication – they just are not specifically pointed to. If one pointer will do, then there is very little reason to point to more codes. The idea is to give enough detail / justification for the service being claimed to actually be paid. The coder who is submitting the claim at the provider picks the 4 best and does not point to the others.
What if more than four (4) diagnosis relate to the treatment? In current EDI (version 5010 of the 837P) the value must be between 1 and 12. On any given service line there are up to 4. How many diagnosis pointers can there be? This is a way to prevent fraud and also a way to avoid paying expensive claims that are really a result of a keying error. If the diagnosis is broken toe and the treatment is removed kidney, the claim will not be paid. For something simple like an office visit, almost any reason will do, but for something more specific they must match. Among other decisions being made is whether the treatment is covered for the diagnosis. After loading the pricing for that provider and determining eligibility and coverage, claims decides if the treatment is covered. Who uses Diagnosis Pointers?Ĭlaims departments use them to determine if they will pay the claim.
#WHAT IS ANOTHER WORD FOR DIAGNOSTIC PROFESSIONAL#
Diagnosis pointers are only used in Professional Claims.
Are Diagnosis Pointers used in Institutional Claims? While the office visit did not address the leg specifically, capturing the diagnosis is still very important.
#WHAT IS ANOTHER WORD FOR DIAGNOSTIC FULL#
For a service that is somewhat generic like an office visit, the patient may have come in because they had the flu, but ended up getting a full evaluation that showed a previous lower leg amputation and perhaps diabetes management. Why not just list all the Diagnosis at the line?Ī properly coded claim often has diagnosis that are not pointed to, but still collected during the encounter. Using pointers meant that no diagnosis code ever had to be listed and transmitted more than once. Transmitting data used to be expensive and charged by the character. When EDI started to be used for claims, pointers were a natural fit for two reasons: First, to keep things the same no matter how the data was submitted (electronic or paper) and second to keep EDI “lean”. Instead, the user just enters a number that corresponds with the diagnosis code they are “pointing” to. As you can see from the image, there is not a lot of room left in the service line area for diagnosis codes. Where did diagnosis pointers come from? Why are diagnosis pointers used?
What are Diagnosis Pointers?ĭiagnosis Pointers are used to describe sometimes complex many to many relationships between submitted diagnosis and service line treatment information on health claims and encounters. If you have any additions, corrections or would like me to answer other questions, please leave a comment. The best way I can think of for now is to put together this diagnosis pointer FAQ. While diagnosis pointers are simple once you understand them, sometimes they are difficult to explain, especially to those outside the claims world. In the last 17 years, I have been asked a number of times to explain diagnosis pointers.
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