Wiki billing question

You could send a corrected claim, as long as you're still within timely filing. Some insurances will re-code the visit to what they deem appropriate. Was this an E&M?
Find out what the actual denial was for. Could it be an incorrect field entry on the HCFA or a wrong diagnosis code? Find out.


You absolutely can down-code. However, it really depends on the reason for the denial. If it is diagnosis related, you will need to research to make sure the correct dx were submitted. If the insurance is strictly denying for the level of care, and your progress notes support it, then down-coding is, in my opinion, your best option.