Hello
wilsonaim2210@gmail.com,
I'll comment on this scenario.
If a provider (clinician) puts in a lab order with a solo diagnosis code that cannot be billed solo/primary diagnosis code; if you have the ability (this sounds likes it is an internal healthcare issue for you from your example) - you will want to query them. They should be able to do an addendum or amendment (based on your internal healthcare policies) to their existing phone encounter to give additional details to comply with the necessary information needed to bill the claim. If not, you adjust the charges off (at the rejection level) or if your facility is able to bill the charges (at the denial level). No RVU's for anyone for that coding scenario.
You either cannot get the claim out the door because of the rejection or if you do; it will be denied for diagnosis issue here.
I do have more to add on the second part when patient goes to Genetics with family history of cancer. First, who is denying? A true denial (you sent the claim out the door, and they stated no reimbursement here)?
OR is this a rejection (cannot send the claim out because there isn't medical necessity).
Please be patient, our clinicians have all these smart phrases and smart texts along with internal policies that make us coders crazy, and they really are unsure what they are coding. Clearly, they went to school to be a doctor, not a coder here. Again, you will query here. AGAIN, please be super kind, I know how frustrating this may be in this specialty. Listen; this may be a learning curve. Educate them, query them, and inquire with them please. Everyone is working together to get to the finish line (Obtaining RVUs instead of
WRITING THEM OFF).
I'll summarize if you don't mind here. If they found out you had to write off whatever testing because D63.8 was applied and it was not billable (
and you didn't reach out and just wrote it off "because they didn't know any better", they would be seriously saddened). They really want to know better. Every single Clinician I have ever spoke to.
I haven't met someone to this day that does not care about RVU's. If I query, it is straight to the point.
1) What is the problem (can't bill xxxxxx diagnosis as primary/solo diagnosis).
2) This xxxxx needs to be resolved before we can bill (addendum, correction, amendment ~ whatever terminology your facility utilizes); please and thank you in advance for reviewing.
3) How do we proceed
I'm super passionate about keeping RVU's to the providers (clinicians). This wasn't the area our clinicians (providers) were trained for. They were originally supposed to see the patients and send this to the coder for review but due to coding shortages this is the way of moving forward.
Thanks for listening,
Dana