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Changing diag codes for workers comp claims

  1. Default Changing diag codes for workers comp claims
    Medical Coding Books
    We have a patient that has been coming here for 6 years. The prior billing company did not follow up (I just took over) and we haven't been paid. They are saying that they can't accept the diagnosis codes and want us to change them to the acceptable codes that they are allowing for the Ohio claim. Is that legal? Are we allowed to do that? This patient has been treating for a back injury that has progressively gotten worse and the diagnosis has changed to represent the changes. What in the world do I do? Ohio Workers Comp owes the doctor over $5,000.

    Please help
    Last edited by mitzfritz215; 11-10-2011 at 03:18 PM.

  2. #2
    Default Bwc claim
    What does the documentation show? Bwc has its own set of rules. Your practice should have a policy in place to address this situation. I have changed the primary code to an allowed diagnosis code but also listed the dx that the physican documented.
    :d

  3. Default
    We have to change numbers in the CMS-1500 form which is difficult as we are unable to change the fields around in the computer system so I will need to hand write all the claims back to 2006 and then they want the allowable diagnosis codes. I am in Florida so I'm not familiar with Ohio's Workers Comp claims. Every time they tell us to change one thing we send it and then they deny it again saying we need to change something else. They sent me forms to fill out to get a BWC# but was told I don't need that if we change around the numbers on the CMS-1500 (doctors SS# plus two zeros in box 25, remove numbers from box 24J, remove numbers from 33 a and add tax ID# in 33b). They sent us a form to fill out for a BWC# but I won't be able to put it in the computer so it will print out. Those fields are already designated for the doctors numbers that are required. If I sent a complaint to the BWC will they assist in helping us get these claims paid. It's a nightmare. Any suggestions?

    Also, I'm a new coder and am trying to clean up a big mess. This is a huge job for me. I'm the only one here in a very small office of 3 people. The doctor, front desk and myself. HELP!!!
    Last edited by mitzfritz215; 11-10-2011 at 03:34 PM.

  4. Default
    I believe that there is a form to fill out online for OHIO to add the diagnosis codes, rather than change the codes I would see if the diagnosis codes can be added to the claim. Changing a diagnosis code for the purpose of payment is not the correct way to bill.

  5. Default
    Quote Originally Posted by penguins11 View Post
    I believe that there is a form to fill out online for OHIO to add the diagnosis codes, rather than change the codes I would see if the diagnosis codes can be added to the claim. Changing a diagnosis code for the purpose of payment is not the correct way to bill.
    OK - I'll look into that.

    That's what's bothering me. It didn't seem legal.

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