Do diagnostic codes affect reimbursement from insurance carriers?
I would be inclined to say yes because the diagnosis determines the treatment codes upon which reimbursement is based. So the appropriate diagnosis code does have an effect on insurance reimbursement.
For an illness or injury Medicare – and I’m sure most commercial insurers – exclude treatment or services that are not deemed to be reasonable and necessary for the diagnosis.
There’s some debate as to whether the diagnosis code(s) should be the initial symptoms or the final diagnosis once testing or evaluation determines the specific illness or condition. I think most coders tend to favor diagnosis coding for the specific illness.
Hope this answers your question – thanks!