Wiki Changing diagnosis

[mcrossley]

How should a situation be handled. A patient came to the ER and CT scans of the brain, neck and a CTA of the neck were ordered. The reason on the order were for MVA and dizziness. A radiology coder coded it out for neck pain, dizziness and stenosis. The only insurance information provided was health insurance. Follow up was done on these claims and a it was of another coders opinion that the diagnosis should be changed to trauma (due to the MVA). My 2 part question is:
1. Should the diagnosis codes be changed to trauma
2. If they are changed, should a corrected claim be submitted to the health insurance to update the new diagnosis codes

Thank you for any input!! Any documentation to reflect your input would be even more helpful!!

 

[thomas7331]

How should a situation be handled. A patient came to the ER and CT scans of the brain, neck and a CTA of the neck were ordered. The reason on the order were for MVA and dizziness. A radiology coder coded it out for neck pain, dizziness and stenosis. The only insurance information provided was health insurance. Follow up was done on these claims and a it was of another coders opinion that the diagnosis should be changed to trauma (due to the MVA). My 2 part question is:
1. Should the diagnosis codes be changed to trauma
2. If they are changed, should a corrected claim be submitted to the health insurance to update the new diagnosis codes

Thank you for any input!! Any documentation to reflect your input would be even more helpful!!

Not completely sure what you mean here - there's no diagnosis code for 'trauma'. Do you mean using an injury code? That might be appropriate depending on what was documented by the providers during encounter, but without seeing the record there's no way to say for sure. In order to code an injury, the physician would have to diagnose some kind of injury (e.g. fracture, contusion, laceration, etc.). You can't code an injury unless the physician found and stated that there was one.

But if a coder has reviewed the record and determined that an injury code is in fact appropriate and was omitted from the original claim in error, then yes, the claim should be resubmitted with the correction.