Diagnosis Coding | Not Just for Claims Anymore

Physician claims are paid based on the fee schedule associated with the CPT^®or HCPCS code that is submitted. Diagnosis coding can be a reason for a denial.

Physicians use CPT^® or HCPCS codes to tell the payer what was done (colonoscopy, office visit) and modifiers to describe special circumstances (assistant at surgery, bilateral procedure.) We use diagnosis codes to tell the payer:

The reason the service was performed,
And, to establish the medical necessity for the service.

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Last revised July 2, 2024 - Betsy Nicoletti
Tags: Code sets and reimbursement

Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions.