tci Medicare Compliance & Reimbursement - 2010 Issue 5
ICD-9 CODING: Stop Asking 'Which Diagnosis Code Will Get My Claim Paid?'
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Article Overview
This premium article discusses ICD-9-CM coding ethics and documentation-based coding practices, with emphasis on medical necessity, payer expectations, and the role of local coverage determinations. It is aimed at coders and billing professionals who need a general understanding of how documentation, claims payment, and advance beneficiary notices relate to diagnosis selection.
Why This Topic Matters
It helps readers understand the distinction between coding what is documented and coding to obtain payment, which is important for compliance, claims accuracy, and payer interactions.
What You Will Learn
- Why diagnosis coding should be based on the medical record
- How documentation and medical necessity relate to claims processing
- What role local coverage determinations can play in coverage review
- How coders may respond when payer coverage and documentation do not align
- Why communication with physicians matters for accurate coding
Who Should Read This
- Medical coders
- Billing staff
- Coding compliance professionals
- Practice managers
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