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Re: GEN: How do insurance carriers do this? (long)From: Joanne Bulley, MD (islesannie@yahoo.com)Sun Feb 27 12:19:19 2005
The issue is not changing diagnosis to somethign that is false to get them to pay -- but situations where EITHER diagnosis is 100% correct - but one is more likely to pay and the othere isn't. Example - there are patients who come in for their annual Pap/etc but are having problems &/or medication management ... if they have an insurance that only pays for preventive care - you bill under the preventive code ... and if they have an insurance that doesn't pay for preventive but pays for problems -- you bill it as an E/M visit. In Garry's 'scope example -- if she has symptoms then I do the scope diagnostically for the symptoms ... If there are no symptoms ... then it is an infertility 'scope. I never code unless I can defend it by the history and chart etc. Joanne
At Sun, 27 Feb 2005, R. Daniel Braun wrote:
>
-- Joanne Bulley, MD Keene, NH, USA
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