Wiki Can you re-order diagnosis codes when the primary diagnosis denied?

[carleycarter26@gmail.com]

I had a claim come back denied due to invalid primary diagnosis code. My question is are we allow to re-order secondary or tertiary diagnosis code in place of the original primary diagnosis code? Please advise, and is there any supporting documentation to support your findings? Any and all input is welcome!! I really appreciate all your help. Thank you!

 

[sls314]

I had a claim come back denied due to invalid primary diagnosis code. My question is are we allow to re-order secondary or tertiary diagnosis code in place of the original primary diagnosis code? Please advise, and is there any supporting documentation to support your findings? Any and all input is welcome!! I really appreciate all your help. Thank you!

Yes, there can be times where resequencing diagnosis codes would be appropriate. The resequenced codes would still need to comply with ICD-10 guidelines, any "code first" notes, etc.

Is this an outpatient claim or an inpatient claim? What is the primary diagnosis that the insurer has stated is invalid? A little more information might help to verify whether resequencing would be appropriate for your specific claim.

 

[thomas7331]

I had a claim come back denied due to invalid primary diagnosis code. My question is are we allow to re-order secondary or tertiary diagnosis code in place of the original primary diagnosis code? Please advise, and is there any supporting documentation to support your findings? Any and all input is welcome!! I really appreciate all your help. Thank you!

If the primary diagnosis was truly invalid, then it should be recoded correctly, not just deleted or re-ordered. If you could provide more specific information about the claim and the denial, we might be able to help a little more though.

You still have to follow coding guidelines and the coding has to be supported by documentation - you cannot just re-sequence or delete codes solely in order to get a claim paid. And as the last post points out, the guidelines are going to vary depending on whether the claim is an inpatient facility claim or not, and also if there is a 'code first' note or other coding instructions involved. There may be situations where it is appropriate to change the sequence, but it will really depend on whether or not the documentation and coding guidelines support this for the record that is involved.