Jackie, I do agree that errors are made on the physician side, but what we're experiencing is that payers are telling the patients that if services were 'coded differently', they would be paid.
In your case, you knew the difference, and understood that it was an error. For most patients, the coding rules aren't common knowledge, and they don't seem to understand why it would be wrong to code for a screening lab, when they already have the disease. And the payers, rather than telling our patients that they simply have different coverage for disease management vs. preventive care, insist that we made a coding error.
To me, that is very, very wrong, and I plan to elevate this at my next state MGMA meeting.
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