Wiki DX listed on Referral

[1CodingTeam24]

I was wanting to see if anyone can help clarify, if the diagnosis listed on a referral is not the actual diagnosis that we will be billing with on our claim will this cause a rejection on a insurance claim.
**Example we typically would use Diagnosis N20.0 and N20.1 for CPT code 50590 but the referral created by the doctors office states N13.2 hydronephrosis with renal and ureteral calculous obstruction.

Thank you.

 

[thomas7331]

You can never know for sure what an insurance company is going to do with a claim - every one has their own policies and procedures. And in any case, you can only assign the code that your provider has documented so you don't really have a choice here.

That said, I think it's highly unlikely that there would be a problem in this particular example you've given. I've never encountered a situation where an insurance company would process a surgical claim and require that the diagnosis match what a referral had on it rather than the diagnosis that the treating physician is giving. Specialists often make a different, or more specific, diagnosis from that which was sent by the referring physician (that's their job and that's often the reason a patient is sent to a specialist in the first place) and this shouldn't be an issue.