Say your provider is performing the technical component of a bone density scan. The diagnosis that was provided by the ordering provider is not medically necessary and your claim has denied.
What are your options with regards to getting that claim paid? Are you able to contact the ordering physician for an updated diagnosis? If they had already shared a copy of their interpretation, are you allowed to use the diagnoses off of that? Are there any other options other than writing off the cost of the test due to medical necessity?
What are your options with regards to getting that claim paid? Are you able to contact the ordering physician for an updated diagnosis? If they had already shared a copy of their interpretation, are you allowed to use the diagnoses off of that? Are there any other options other than writing off the cost of the test due to medical necessity?
, I only laugh because of the trauma involved in this. So I am not sure your internal policies if you can append a new diagnosis from the interpretation, I am not a radiology coder, but I would think if supporting documentation shows its medically necessary then it is correct to change it, but I am not sure if the Professional side has to be corrected too, again I would ask a manager. However this is why they have Medicare patients sign ABN's so that if it is not medically necessary you bill the patient. But if you didn't get that signed then you would need to write it off. Or for non medicare patients its a financial responsibility agreement, so in the event its not medically necessary you can bill the patient.