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Diagnosis question and payor policy

  1. #1
    Question Diagnosis question and payor policy
    Medical Coding Books
    I have submitted a claim for a procedure and diagnosis to a primary payor which has paid according to guidelines and policy. Now the secondary payor is denying because of their guidelines. Is it unethical to change the diagnosis for the secondary payor, even when guidelines and policy are still being followed, in order for the remaining cost to be paid? Thanks for any suggestions.

  2. #2
    Be a little more specific - (if you can type the note, that would be really helpful) - what did you bill, with what Dx, and who are the insurers? (Follow-up is my specialty - I may be able to help you with an appeal...)

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