Wiki Unspecified Dx- who should fix it?

[sfoster465]

I am unsure how to approach an issue I am encountering when screening claims. I just started as a Revenue Cycle Specialist at an ENT office, and one of my providers is constantly coding unspecified Dx. I brought this up to my supervisor asking if we can work with the provider to have him move away from coding unspecified and instead use bilateral (if appropriate) or definitely specify laterality, but now I am wondering if that should ultimately be up to me since it is my responsibility to make sure the claim is clean and complete before submitting to insurance. Of course, unspecified codes are appropriate in some cases, but we have been getting many denials for not coding to the highest specificity, and I am hoping to get this straightened out ASAP.

Thank you for any input!

 

[sfoster465]

I answered my own question- the Dx is pulling from the note, so the notes are not specific enough. This is something the provider needs to work on.

 

[dineshkumar.p7@accesshealthcare.com]

provider documentation(operative report or Encounter document or progress notes) must support specificity and laterality (right or left or bilateral) of the diagnosis codes. if specificity and laterality not present then we need to query the provider regarding this and will get information from provider office to submit a claim.

diagnosis codes, diagnosis coding