Diagnosis Coding is Vital to Fair Compensation

Diagnosis Coding is Vital to Fair Compensation

Polk & Associates CPA

In a fee-for-service environment, physician reimbursement is based on the fee associated with a CPT code. The diagnosis code establishes the medical necessity for the service, telling the payer what symptoms, conditions, or diseases necessitated the visit, diagnostic test, or procedure. Almost any diagnosis code (except some V and E codes in ICD-9) supports the medical necessity for an office visit or other E&M code, whereas the diagnosis codes that support a procedure or diagnostic test are typically limited and often specific. In either situation, using a current, valid diagnosis code gets the claim paid.


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