Wiki picking up DX codes from worker's comp C9 form

[marybethscoding]

Hello

I am a coder for a facility in Ohio, and the question has been raised as to the legitimacy of picking up DX codes from the C9 form on a worker's compensation claim. We have had a denial as we did not use that code, as it was not documented in the physician documentation. The code on the C9 was also a unspecified code, and the physician did have a specified code documented. Can these DX codes on this form be used for reimbursement purposes? Any direction will be greatly appreciated.

 

[SharonCollachi]

First, remember that Workers Comp is NOT subject to the same rules as regular healthcare, regarding coding and billing. If the work comp carrier (for any state and for federal) has decided they will only pay for a specific dx code, then treating any other dx code will be paid under private insurance, not work comp.

The C9 form for Ohio is to request services. The code on the form should be what the claim is accepted for, and what the patient is being treated for.