Question

Choose three medical procedures and research possible diagnoses include why the diagnoses would justify medical necessity for the procedures that you chose. Explain the importance of code linkage and what the consequences for not showing.

Answer 1

Answer: The three medical procedures are chest x-ray, sputum AFB test, and colonoscopy.

The chest x-ray can identify pneumonia, cystic fibrosis, tuberculosis. Most of the diagnoses are related to the lungs or respiratory system. It is necessary to understand any changes in the lung structure. Any abnormality of the lung structure can be identified with the help of a chest x-ray.

Sputum AFB test is done to identify Pulmonary tuberculosis. Sputum AFB test helps to identify the acid-fast bacillus of mycobacterium tuberculosis. If a positive test shows tuberculosis.

A colonoscopy helps to diagnose colon cancer. Colonoscopy is a procedure used to visualize the inner structure of the colon for any overgrowth of the cell leads to the identification of colon cancer.

Code linkage is the verification match up of the procedure code and the diagnosis code to support the medical necessity of the procedure. The consequence of not performing proper code linkage leads to an overpaid, not paid, or less paid procedure bill by the patient. Denied of paid by the insurance company for the patient because of not link the necessity of procedure to the diagnosis. For this wrong code linkage, the pateint can file fraud cases and get panalties for it.