Urgent care dx denials

dneiman

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Hello, I am hoping someone with UC experience can give some insight; at UC we do not have the facility to send labs for every dx. Certain dx require the cause of the dx, such as pneumonia (J12-15.X) or J06.9 "acute upper respiratory tract infection, unspec" wants the bacterial cause. We are starting to see payers refuse payment on codes with the "unspecified" designation on these. Is there any other alternative, or are we stuck with dx that will not be covered? Any insight or advise would be deeply appreciated.

Deb Upington
 
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