Third Party e-MDs Billing Tip: Diagnosis Order Matters
When we start with practices, we tend to see billing issues in a variety of areas. One of the most common ones is diagnosis linkage and order. In this week’s Billing Tip for e-MDs Practices, we’ll try and clear up some of these issues.
When a patient is seen and has more than one diagnosis, relying on the system to place your diagnosis in the proper order can be tricky. The order that e-MDs chooses might not reflect the medical necessity of the order that the provider intended. It’s not the system’s fault. This simply is a function of how the provider places the orders in the note. So when you are in the daily work list and open up the new invoice to be created: (see screenshot below)
In this example, we see Hypertension list first and marked in bold as primary. You change the order by simply clicking on the code that you want to move and then click on the light blue arrows (purple arrow) to move the code up or down. Also, you can change the primary diagnosis by clicking on the diagnosis that you want to be primary and then click on the “Set Primary ICD” button (red arrow).
To determine the proper order, the most serious diagnosis should be put first which can be determined by:
- What was the primary reason for the visit?
- Of the conditions, which has the highest risk of mortality or morbidity that the provider is seeing them for on that day?
After the primary diagnosis, you can list any other diagnoses that the patient presents with. Make sure to check the chart note to ensure that conditions that were previously treated no longer exist. You can certainly use history codes such as Z80-Z87 if the family or historical condition has a direct impact on the current care or treatment of the patient.
Mental health codes are often a source of confusion as well. If you list those codes in the primary diagnosis spot, oftentimes the claim will be paid at a reduced rate as many insurance companies will only pay limited benefits for mental health claims. In the scenario from the screen shot above, you would not want to move F33.1 to the primary spot unless the note suggested that the conditions previously mentioned (Primary reason/ mortality) were in effect.
In summary, it’s always a good practice to review the notes from the encounter prior to assigning ICD order placement and primary designation. The e-MDs system will put them in the Invoice Prep screen based on the order the provider puts them in the note, not necessarily the order in which they should be coded. Let us know if we can be of assistance to your practice by filling out the contact form below.
Solor is a specialized third party medical billing company for e-MDs® Practices. e-MDs® is a registered trademark of e-MDs Inc. e-MDs Inc. is not affiliated with Solor, Inc., our products, services, or website. Additional legal disclaimer here: http://wp.me/P7cvJE-kI
