Emergency Department Diagnosis that are on an Auto Pay List
One of our Managed Medicaid Products requires us to list a diagnosis that is on their Auto Pay List in the primary diagnosis spot in order to be paid. If we don't, we are only paid a triage fee or must send in medical records. If a patient comes in with chest pain and it is determined to be GERD, our coders say that they can not code the symptom of chest pain (which is on the auto pay list). Instead, they will need to code GERD (which is NOT on the auto pay list). Does anyone have any suggestions on how to operationalize this process or make it smoother? Thank you.
Sign In to comment.