Why Link ICD-9 Diagnosis Codes to CPT Procedure Codes?
“Medical Necessity Denials” Failure to link the ICD-9 diagnosis code and the CPT procedure code could result in a denial for the claim submitted. CPT codes tell the Payer what you did while the ICD-9 codes will tell the Payer why you did it. The ICD-9 code should show medical necessity by linking the appropriate diagnosis, symptom or complaint to the treatment (CPT). Although the HCFA 1500 claim form allows you to submit up to four ICD-9 codes, some carriers including Cigna/Medicare will only look at the first code listed for each service billed. Therefore it is very important that you link the ICD-9 code to the service. It is also critical that the data entry staff understands this concept and is linking procedures and diagnosis at charge entry. If the data entry staff do not link the charges and diagnosis as designated by the physician, your services may be denied. Remember: the ICD-9 code must support the medical necessity for performance of the procedure and this information must b
