Physicians Practice July 2, 2014
Years ago, I worked with the surgeon who wanted to list all of the patient’s underlying medical conditions on the claim form for the surgical service. He would say to me “Betsy, I want the insurance company to know just how sick this patient is.” The thought-bubble over my head was “the insurance company doesn’t care.” But that was then and this is now. In fee-for-service medicine, physician services are paid based on the fee associated with the CPT or HCPCS code submitted on the claim form. The diagnosis code supports the medical necessity for the service and tells the payer why the service was performed. It can be the source of denial if it doesn’t show the medical necessity...
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