Physician claims paid based on CPT®, are often denied based on diagnosis codes
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.
- The medical necessity of the service.
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Additional resources
The CodingIntel Guide to Hierarchical Condition Categories provides a comprehensive list of HCC and Risk Adjusted Diagnosis Coding resources available on CodingIntel.