CKBeatty
Guest
Family Practice having several ICD-10 codes denied as unspecified. Any advise?
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Wiki ICD-10 Unspecified Denials
- Thread starter CKBeatty
- Start date
Jessim929
Guest
Do you have any examples? Is the diagnosis not coded to the highest specificity?
mitchellde
True Blue
I tell my students that when they decide to use an unspecified code they need to look in the note to see if there is any reason the provider could or should be expected to be more specific or is it a case where there is simply not enough information available to be more specific. For instance if the provider knows the blood count is low they can diagnose the patient as having anemia, however with no more test results available would they be expected to know the type of anemia. The answer is most likely they would not, so anemia unspecified is a good code. However, an unspecified body part or unspecified organ would never be acceptable because the provider is expected to know which one they are looking at, touching, concerned with or otherwise testing.
You should always be prepared to defend your code choices for a payer should it be denied for lack of specificity.
You should always be prepared to defend your code choices for a payer should it be denied for lack of specificity.