MargoR
Networker
Good morning,
We have been receiving some denials by workers' comp on diagnosis not part of the injury referral to Ortho provider.
Example:
Referral from W/C payer/adjustor states sprain to RT wrist w/diagnosis S63.xxxA ICD10 code.
Patient was evaluated by Ortho provider, x-ray confirmed FX to wrist S62.xxxA.
Confirmed diagnosis of FX to wrist was used as primary on claim, this was denied for not part of work-related injury. Our billing department does call the adjustor to explain the confirmed diagnosis, but this takes a while, does anyone know where I can find guidelines/policy to drop claim with the W/C payer/adjustor primary DX for referral?
We should be following ICD10 guidelines etc.., but I do remember reading if a payer has specific guidelines that will affect reimbursement, we should follow those guidelines. So, if anyone has that resource please share.
Thank you
We have been receiving some denials by workers' comp on diagnosis not part of the injury referral to Ortho provider.
Example:
Referral from W/C payer/adjustor states sprain to RT wrist w/diagnosis S63.xxxA ICD10 code.
Patient was evaluated by Ortho provider, x-ray confirmed FX to wrist S62.xxxA.
Confirmed diagnosis of FX to wrist was used as primary on claim, this was denied for not part of work-related injury. Our billing department does call the adjustor to explain the confirmed diagnosis, but this takes a while, does anyone know where I can find guidelines/policy to drop claim with the W/C payer/adjustor primary DX for referral?
We should be following ICD10 guidelines etc.., but I do remember reading if a payer has specific guidelines that will affect reimbursement, we should follow those guidelines. So, if anyone has that resource please share.
Thank you