Question

What is code linkage in claim creation? Why is it important to ensure that codes are linked appropriately? What are the consequences of failing to perform code linkage?

Answer 1

code linkage is the verification that diagnosis code and procedure code match up to support medical necessity for the procedure. Failure to link the codes can result in claim denials.

importance

The purpose of code linkage is to prove medical necessity and give insurance companies a reason to pay a medical provider.Code linkage connects diagnosis code to properly match up with procedure code .It is imperative for the diagnosis code to properly match up with the procedural code. A lack of code linkage or code linkage that does not demonstrate medical necessity will prevent a medical practice from getting paid.

Having the proper medical coding ensures that insurers have all the diagnostic codes required for appopriate payment .Coding also critical for demographic assessments and studies of disease prevalence, treatment outcomes and accountability based reimbursement systems.

consequences.

Failing to link diagnostic codes;

A CPT or HCPCS code tells the payor what service was performed. The diagnosis code tells the payor what service was performed,The diagnois code tells the payor the reason for the service. Some patients present for more than one condition may require unrelated services.Other patients may receive a service that is only covered for a specific indication. For example, say a patient presents to a family physician for hypertension, and code for wart distruction must be linked with the diagnostic code for warts. Most often, only one diagnosis is listed or linkeed and denials are then given.

selecting wrong procedural codes;

With more than 75000 CPT codes, it is easy to select an incorrect procedure code. However , the source of such an error usually not confusion about the procedure performed. Incomplete or inaccurate  code descriptions on encounter forms, cheat sheets, and electronic charge systems are significant source error. Failure to read the editorial comments at the start of the section, in the CPT book or the notes near the code is another cause of this type of error, as it is not reading specific coding companions available to assist in special circumstances.

Unbundling codes

When there is a single code available that captures payment for the component parts of a procedure, that is what should be used. Unbundling refers to using multiple CPT codes for those parts of procedure.either due to misunderstanding or in an effort to increase payments.