I've been told that claim will be denied by Medicare if the primary DX code on a professional claim is the same as the primary "admitting DX code" listed by the hospital. In other words if "pneumonia" is listed as the admitting DX by the hospital and the physician who saw the patient in the hospital lists pneumonia as the primay DX that it will be denied. This is for Medicare only....not commercial payers...just wondering and if so, what is the rationale behind it. Your input is appreciated.
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