It’s common to see a patient in your office but be unable to provide a definitive diagnosis at the time of the visit.
If you don’t have a diagnosis, document your assessment using the diagnostic codes appropriate for the patient’s symptoms and wait for your confirmatory testing to come back.
Once complete, those tests may indicate specific diagnoses for which additional financial resources are provided (i.e. risk codes)—organism-specific pneumonia on a sputum culture, osteoporotic fracture on back films, atherosclerotic changes on plain films all come to mind.
If that happens to you—you have a new best friend.
When you can make a diagnosis based on test results ordered at given visit, submit an addendum.
Include documentation of new diagnostic results you just reviewed, how they changed or didn’t change the treatment plan and submit the information with a specific revision of the initial code submitted at the original visit.
Those diagnosis codes can be submitted to CMS through the insurer. If they increase your capitation, so much the better.
Don’t know how? Ask the professionals up your revenue cycle workflow— your coder, your biller, your billing agent.
They’ll know. And they’ll help you set up a workflow to do it right.
Routine use of addenda is a tool that’s CRITICAL for success in risk-sharing contracts.
You simply CANNOT harness all the revenue you are due without them.
Make it your business to learn how it’s done—especially for x-rays and sputum cultures.
Sounds like a hassle, but the payoff can be enormous.
Your patient will get better care and the insurer will have a more accurate picture of their disease burden.
And you may end up with more resources to care for your patients.
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