During processing of the encounter form (to generate the claim), the insurance specialist notices that the provider entered a ch
eck mark in front of the procedure, "Blood, occult (feces)," and a check mark in front of the diagnosis, "Hypertension." Because medical necessity requires the diagnosis selected to justify the procedure performed, what should the insurance specialist do next?
The diagnosis is a total misnomer.There was no correlation between the diagnosis codes and the procedure carried out.Therefore the issuance officer needs further clarification from the health provider in charge to verify the accuracy of the codes for possible error to avoid misinformation.
