Changing DX order

sherri greenwood

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Local Chapter Officer
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Fort Smith, AR
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Patient has an insurance plan that has a rider that migraines are not covered. Comes in for migraines, hypertension,hyperlipidemia. All dx are on claim, but migraines are listed first, scripts were given for all and all were discussed at appt. Dictation states patient here for follow up and having migraines. Can I move migraines to 3rd position to see if insurances will pay since she was also treated for HTN and hyperlipidemia. The insurance is Golden Rule United Health One.

TIA
 
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Patient has an insurance plan that has a rider that migraines are not covered. Comes in for migraines, hypertension,hyperlipidemia. All dx are on claim, but migraines are listed first, scripts were given for all and all were discussed at appt. Dictation states patient here for follow up and having migraines. Can I move migraines to 3rd position to see if insurances will pay since she was also treated for HTN and hyperlipidemia. The insurance is Golden Rule United Health One.

TIA

Based off what you've posted, the migraine DX should be listed first as it's the "active problem"; then the HTN and hyperlipidemia since they are apparently well-controlled and just needed med refills. You can't re-sequence the DX codes in an attempt to get payment; no matter what, the migraine DX is going to be on there. If the claim denies due to the rider, you could try to appeal with documentation explaining that the other conditions were also addressed during the visit and see if they'll reimburse at least a portion of the cost. I wouldn't hold my breath though.

The patient knows (or should know) the rider exists and should be well aware that the visit will likely not be paid for by the insurance. Unfortunately, there would be no option other than to balance bill her.
 
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