ED Coding & Reimbursement Alert - 2019 Issue 5
Reader Question: Avoid Denials, Check Code’s LCDs, ICD-10-CM Crosswalk
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Article Overview
This reader Q&A discusses a denied claim for a Medicare procedure and outlines two broad ways coders can evaluate whether the diagnosis information supports payment: checking applicable Local Coverage Determinations and reviewing an ICD-10-CM crosswalk. It is intended for medical coders, billers, and reimbursement staff who need a practical way to assess whether a claim should be corrected or appealed, and it highlights the role of payer policy and supporting documentation.
Why This Topic Matters
Denials tied to diagnosis-code incompatibility can delay payment and require additional work to resolve. Understanding where to verify coverage and how to confirm diagnosis alignment helps coding and billing teams decide whether a claim may need resubmission, further review, or appeal.
What You Will Learn
- How to evaluate a procedure denial against payer coverage policies
- How an ICD-10-CM crosswalk can be used to review diagnosis compatibility
- Why documentation support matters when a diagnosis is submitted for payment review
- How to think about resubmission versus appeal when no crosswalk match is found
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance staff
- Practice managers
Codes Discussed
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