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Medicare not paying but charging to process claims with too many icd9 codes

  1. Default Medicare not paying but charging to process claims with too many icd9 codes
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    I am an auditor in a family clinic and my billing department has informed me that medicare is not only not paying claims with too many icd9 codes, but is charging us to process them. This just started with 2009 claims. The charges range from $3 to $30. These are all related to one provider. This provider's documentation actually supports the number of diagnosis, i.e. Ordering tests, rx'ing meds, etc. According to icd9 guidelines "code all documented conditions that affect patient care" makes it difficult for the auditors to justify questioning the provider for too many pov's. Now we have justification with medicare not paying the claims, but how do we reconcile this with the icd9 guidelines. Ask the provider to limit the number of issues they deal with at each visit? If anyone has any input to this issue or has encountered this problem, i'd appreciate hearing from you.

  2. #2
    Default
    What FI are you dealing with? I have never heard of this, I thought they only recognized up to 8 ICD-9 codes though.

    Thanks

    Laura, CPC

  3. Default Joanne CPC
    RE this portion of your comment:

    According to icd9 guidelines "code all documented conditions that affect patient care" makes it difficult for the auditors to justify questioning the provider

    You also mentioned "visits". I assume you are billing for the physician? If so, "code all documented conditions that affect patient care" is for Hospital coding and not provider. Another post commented on FI, so I am not sure if you are billing Part A or B. The ICD-9 guidelines are different, hence having the physician ICD-9 and facility ICD-9, and the FI and the Carrier/MACs are surely different.

    If you are billing Part B, you should only bill the ICD9 reason for seeking treatment. Code Also ICD9s should be accepted by Part B, but non treated diagnoses won't.

    Could that be the problem you are facing?

  4. Default
    Thank you for your responses. Per my billing dept., because we are an fqhc clinic we bill under medicare part a, subsidiary b (this sounds confusing, i know.) also, our fi is national government services, which we just switched to several months ago. I do realize guidelines are different for outpatient vs. Inpatient, and we follow physician guidelines. As for the number of codes recognized, evidently all of them are in this case. Should we only submit a limited number of diagnosis?

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