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Thread: Change diagnosis for reimbursement

  1. #1

    Default Change diagnosis for reimbursement

    AAPC: Back to School
    Since Medicare only allows 12 visits with the same diagnosis for chiropractic I have been asked to go back to the file cabinet and pull the original diagnosis sheet that was sent with demographics and pick a new set of diagnosis and switch them around for reimbursement. I refused and would like to know if anyone has any advice to offer or documentation to support the fact that the diagnosis either needs to be chosen from the documentation for that visit or the doctor needs to specify on his charge sheet. Please help! Thank you.

  2. #2
    Join Date
    Apr 2007

    Default Code Selection for Reimbursement

    Code selection is based strictly on documentation in the medical record. Switching around codes for the sake of reimbursement would be considered fraud.
    Heather Winters, CPC, CFPC

  3. #3
    Join Date
    Apr 2007

    Post Corporate inferno

    You can retrieve diagnoses from a past encounter just as long as the diagnosis retrieved is the reason for the procedure being rendered. It is kind of bending the rules but it is not fraud. Listing a condition as principal/primary that isn’t the reason for the procedure but sequenced in ordered to get paid is unethical, but then again corporate coding is prone to this type of encryption because of our crumbling uninsured economy.

  4. #4
    Join Date
    Apr 2007
    lauderdale lakes


    I billed for Chiropractic in CT. I was never given a problem by Medicare. I billed for the visits and never had any denied. Some patients came one a week for the whole year and everything was paid. no notes were ever asked for.

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