The diagnosis codes tell the payer why the ob-gyn performed the scan. And carriers will deny payment if the ICD-9 codes are not specific enough. You can ensure you are coding to the highest level of specificity and showing proper medical necessity by following a sound coding and assessment process, which has three steps:
1. Gather complete information. The ob-gyns written notes may not have enough information for you to code correctly. To make sure you have the details that you need, consider using an encounter form that lists the common diagnoses along with a clear indicator when more specificity is needed. This will help educate the doctor regarding which ICD-9 codes require more information. For example, you can use a line after the code to clearly indicate that you require more digits (for example, 256.__).
2. Use the code with the highest specificity. No matter how well the ob-gyn communicates the patient data, you must ensure that you have the right code and that you carry it to the highest digit possible. Note any caution or warning symbols in the ICD-9 manual (some color-coded books use yellow for nonspecific codes and red for those with missing digits), and know your DEXA scan terminology well.
The simple rule is: Assign three-digit codes only if there are no four-digit codes within that code category, assign four-digit codes only if there are no five-digit subclassifications for that category, and assign the five-digit codes for those categories where they exist.
3. Run frequent reports. Approximately every two months, use your billing software to generate a report of the top 50 diagnosis codes and top 50 CPT codes each physician used. Carefully review the reports, noting which nonspecific codes the ob-gyns used and how often. Report this information to the physicians and keep track of each report to benchmark progress and trends.