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Thread: Unspecified vs Specified ICD9 Codes

  1. #1

    Default Unspecified vs Specified ICD9 Codes

    AAPC: Back to School
    Hello everyone. How does billing with an unspecified (285.9) code vs a specified code affect the reimbursement of a claim?

  2. #2
    Join Date
    Apr 2007


    Claims are processed/paid by the procedure code not the diagnosis code so it shouldn't matter.

  3. #3
    Join Date
    Apr 2007


    I disagree that claims are paid on procedure only. (sorry) It's important to use the correct Dx for the procedure done- check medicare and private ins LCD's for approved codes.

    Using NOS or NEC codes are fine and will not affect reimbursment as long as they are relevant to the procedure performed.

    You are telling the "story" of the procedure, so be as specific as possible.

  4. #4
    Join Date
    Apr 2007


    I agree that payment is not only based on procedure. Very simple procedure may be denied just because it was not billed with correct Dx. CPT is used to explain what the Dr. did and the Dx- to establish a medical necessity for the procedure performed. If we follow the logic of HELEN BULLOCK, CPC then we can bill for an amputation of foot or hand based on dx 784.0 (Headache). I personally dont think it is possible. As far as using NOS or NEC dx, I also believe that it should not affect the payment.

  5. #5


    Thank you all for response.

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