Neurology & Pain Management Coding Alert

Be careful not to put words in your neurologist's mouth, or risk audit woes. Imagine your neurologist providing pain management services for a patient presenting with a complaint of chronic pain, but at the time of the visit your neurologist is unable to uncover a definitive diagnosis. While you know that altering or guessing a diagnosis to ensure payment is a huge no-no, there are proper codes you can choose from to handle the situation. Stay Sharp Interpreting Doc's Docs Specificity in diagnosis coding is always important, but it is increasingly vital because-"third party payers are establishing more stringent coverage criteria for therapies and procedures and are using automated edits to deny claims based on the lack of a covered diagnosis," says Mary H. McDermott, MBA, CPC, with Johns Hopkins University in Baltimore. "Using a non-specific diagnosis code which may be -close-- but not exact-may mean you will-not be paid [...]