Option to mark Diagnosis codes as Informational/Non-Billable
When in the PM, would like a way to mark certain diagnosis codes as Informational or Non-Billable and would keep them from going out on claims. They state that there are certain codes they need to put on the patient't chart that help them meet measures, but when the codes get sent out on claims, it causes the claims to come back with errors. They are valid ICD10 codes BUT insurance companies(NC Medicaid and Medicare) deny the claims if these codes are placed on claims.
Requested Steps to define spec: In the PM, under the Maint tab, click on Diagnosis. Choose any code. When the Diagnosis Detail box opens, the client would like an option of Informational or Non-Billable to be in this window.
Expected Result: By checking the box next to Informational or Non-Billable, it stops the code from going out on claims.
Actual Result: There is no option for the client to have the option of Informational or Non-Billable. Non-Billable codes are being sent out to EDI and EDI is sending them back because of invalid codes.
Impact on Workflow: Employees have to correct all the claims that are being sent back. Or they are having to call EDI to get a postloader to strip all the Non-Billable codes out of the claims being sent over.
Courtney Smith
shared this idea
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After some research found these are valid billable codes in situation when used properly on claims. Having this kind of option may cause further issue when the code needs to go out on a claim. I would suggest they add cross code messages to their codes so a biller will get a prompt that they may want to remove the code or at least the pointer from the claim if it doesn’t fit the claim situation. Or setup a rule in the Rules Manager so when Batching EB claims it flags the claims with the Z code dx. Coder believes the best maybe the cross code msg and the biller make the decision to remove the pointer or code or not remove since it maybe necessary on a claim.