3 ms·

Believe it or not, these codes are used to define contracts and aid in payment all the way from patient to broker.

by jjm 11y ago

hga 11y ago
So, pretend I'm a doctor and tell me, will I get paid more for S61.354D Open bite of right ring finger with damage to nail, subsequent encounter Or S61.355D Open bite of left ring finger with damage to nail, subsequent encounter ??? And with such specificity, why include this code: S61.359D: Open bite of unspecified finger with damage to nail, subsequent encounter I'm assuming "other finger" is the one between your little and middle ones, and we'll all sleep easier knowing that, while not found with jhulla's search, your left and right thumbs have not been neglected.
- Mz 11y ago
  I actually used to pay insurance claims. Sometimes, the question being answeed is how many fingers we are paying for. To know that, we sometimes need specifics. There were enough fraud claims where someone was wanting to be paid for a third leg amputation that we joked we needed LL (left) R (right) and M (middle) as our designations instead of just L and R.
- dragonwriter 11y ago
  Generally, you don't get paid an amount for a diagnosis, you get paid for the services you bill. Whether a payer accepts that the specific services you billed for are medically appropriate and thus pays them depends, often, on the diagnosis they are treating. (And, often, there are three possibilities: the payer pays the claim directly, or the payer requires additional supporting documentation which is manually reviewed before making a decision, or the payer denies payment outright.) The more detail diagnostic coding provides (and, for that matter, the more detail procedure coding provides), the more an automated system can move cases that would otherwise be in the manual review category (which adds costs for all parties, and delays) to an automated decision (which is quicker and cheaper for all parties.)

Believe it or not, these codes are used to define contracts and aid in payment all the way from patient to broker.

by jjm 11y ago

Believe it or not, these codes are used to define contracts and aid in payment all the way from patient to broker.

hga 11y ago

So, pretend I'm a doctor and tell me, will I get paid more for S61.354D Open bite of right ring finger with damage to nail, subsequent encounter Or S61.355D Open bite of left ring finger with damage to nail, subsequent encounter ??? And with such specificity, why include this code: S61.359D: Open bite of unspecified finger with damage to nail, subsequent encounter I'm assuming "other finger" is the one between your little and middle ones, and we'll all sleep easier knowing that, while not found with jhulla's search, your left and right thumbs have not been neglected.

Mz 11y ago
I actually used to pay insurance claims. Sometimes, the question being answeed is how many fingers we are paying for. To know that, we sometimes need specifics. There were enough fraud claims where someone was wanting to be paid for a third leg amputation that we joked we needed LL (left) R (right) and M (middle) as our designations instead of just L and R.
dragonwriter 11y ago
Generally, you don't get paid an amount for a diagnosis, you get paid for the services you bill. Whether a payer accepts that the specific services you billed for are medically appropriate and thus pays them depends, often, on the diagnosis they are treating. (And, often, there are three possibilities: the payer pays the claim directly, or the payer requires additional supporting documentation which is manually reviewed before making a decision, or the payer denies payment outright.) The more detail diagnostic coding provides (and, for that matter, the more detail procedure coding provides), the more an automated system can move cases that would otherwise be in the manual review category (which adds costs for all parties, and delays) to an automated decision (which is quicker and cheaper for all parties.)