Wiki claim denial and rebill

[wynonna]

So a claim back came back with a denial for unspecified code--H90.5--sensorineural hearing loss which should say on progress note H90.3 for the more specific code as of Oct 1 when 2021 ICD10 CM came out.
Are we allowed to rebill claim with correct diagnosis (H90.3) and have MD make an amendment to his note to change ICD10 to the more specific (H90.3) so we can send the most updated and correct progress note with rebilled claim?
thank you

 

[csperoni]

You may certainly rebill a corrected claim (assuming you are within the plan's timely requirement) along with documentation
Depending on documentation, the provider may not need to amend his note. If the physician wrote "sensorineural hearing loss, bilateral" or the equivalent, it's not ideal, but not required that H90.3 must be in the note. Depending on your EHR, and office policy, sometimes the ICD10 codes are not even on the note at all. If the clinician simply documented "hearing loss", then an amendment is in order. Think of it as:
It is the physician responsibility to assign and document a diagnosis/problem.
It can be the coder (or biller) responsibility to assign the code to the already documented diagnosis/problem.
The coder cannot change the diagnosis, but can correct the code.

BTW, it looks to me like H90.3 was added 10/01/2015 and not just on 10/01/2020.