I can only tell you what I was taught and even told from people who worked at places like Blue Cross Blue Shield.
Using "unspecified" codes can cause an insurance company to wonder what's going on. To them, it's like your practice is trying to hide something in the hopes of getting more money since you're not being all that specific with your coding. And we all know what THAT can lead to. Can you say audit?
You're right in thinking that more and more insurance companies will not pay if they catch your practice over using the "unspecified" codes and they will for sure if you do it too much. Sure... sometimes you don't have a choice because procedures change between updates and new diseases or variations of old ones are discovered all the time and that's why there are unspecified codes, but my understanding is that they should really be used sparingly.
Besides... I've seen ICD-10 and the codes are even more specific than the ICD-9 codes. It's going to be interesting once the transition happens.
It's my hope that you're physicians will start now being more specific with their Dx and even their procedures to get into the habit before the transition to ICD-10.
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