lcoe0519
New
I have a couple of questions. I have been handling denials and writing appeal letters for about a year now. I was sort of thrown into this position. My first question is, can anyone offer me any kind of resources or webinars, online learning opportunities so that I can make better arguments and write better letters? I've done okay so far, but things are getting a little more intense for me and I want to make sure that I'm capable and educated.
My second questions is this, I am currently working on an appeal. The patient suffered a bowel perforation during a colonoscopy. The coder incorrectly assigned the code for a traumatic laceration to the colon as the principal diagnosis, DRG 329. The RAC auditor submitted a denial saying the principal diagnosis should have been K63.1, Perforation of intestine (nontraumatic). While I agree the that traumatic laceration was incorrect, I disagree with K63.1. I believe the correct principal diagnosis should be K91.71, Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure with K63.1 as a secondary diagnosis. We still lose money on reimbursement, but not as much. So can I write a letter arguing that K91.71 should be principal?
My second questions is this, I am currently working on an appeal. The patient suffered a bowel perforation during a colonoscopy. The coder incorrectly assigned the code for a traumatic laceration to the colon as the principal diagnosis, DRG 329. The RAC auditor submitted a denial saying the principal diagnosis should have been K63.1, Perforation of intestine (nontraumatic). While I agree the that traumatic laceration was incorrect, I disagree with K63.1. I believe the correct principal diagnosis should be K91.71, Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure with K63.1 as a secondary diagnosis. We still lose money on reimbursement, but not as much. So can I write a letter arguing that K91.71 should be principal?