Billing DX vs. Medical DX
I have never heard of a difference in the "billing" dx vs the "medical"dx. However, it has been my experience that some "billers" upon getting a denial for non covered services due to dx will "change" the diagnosis to a "billing diagnosis". In other words, if the correct diagnosis as documented by the provider is a non covered diagnosis for the procedure, lab, etc. which causes a claim to be denied, then some insurance follow up people, or billers, etc. have been known to look for a covered diagnosis and "assign" that code in order to get a claim paid. As you all know, this is unacceptable. If a diagnosis is not covered by the local or national determinations, then an ABN needs to be obtained prior to performing the service so that a patient may be billed. This is the only type of scenario that I can imagine where the "billing" dx and "medical" dx might be different. As a certified coding instructor, I always make sure that my coding students learn early on the importance of assigning only properly documented services and diagnosis. Sylvia Adamcik, CCS-P, CPC-I, CPC