For services billed to a HNS contracted payor, as a general rule, the diagnosis must be related to a neuromusculoskeletal condition. (See individual payor corporate medical policies for when chiropractic services are covered.)
All diagnoses reported on the insurance claim must be documented in the health care record.
The diagnosis or diagnostic impression must be reasonable based on the patient’s chief complaint(s), results of clinical findings, diagnostic tests and other available information.
Diagnoses reported on insurance claims must be consistent with HNS and HNS payor policies, the policies of applicable licensing boards, as well as state and federal laws.
The patient’s healthcare record must reflect ALL diagnosis/clinical impressions.
Any changes in diagnoses must be documented in the patient’s health record.
The provider must utilize the ICD codes that appropriately reflects the findings of the patient visit and supports the necessity of care.
diagnostic impression