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The solution is designed to help reduce improper upcoding and alleviate the need for hospital coding staff to downcode
procedures due to inadequate documentation.
An increase in the number of indicators would reduce the focus on particular diagnoses and diffuse pressure to downcode
administrative data for safety reporting purposes.
And the insurers will no longer automatically downcode
evaluation and management codes, and will separately identify and pay modifier -25, which allows physicians to bill for evaluation and management service on the same day as a procedure.
And both will no longer automatically downcode
evaluation and management codes, and will separately identify and pay modifier-25, which lets physicians bill for evaluation and management service on the same day as a procedure.
First they don't look at them to downcode
, and then, when you appeal, they say, 'Well, we need the medical records.
Instead of taking time to pull out a coding reference, physicians may intentionally downcode
to ensure that their documentation supports their code, or they may erroneously apply a higher service code not supported by the details they have documented.
4, 1955, and have engaged in a common course of fraudulent conduct to automatically delay, deny and downcode
their reimbursement of health care costs and to deny expensive but necessary medical treatments.
It is important to appeal non-standard coding denials and require carriers to explain such coding edits, downcodes
and denials in a claim-specific manner.