Claims Rework Due to Treatment or Diagnosis Code Changes

If the therapist changes a patient's diagnosis code or the treatment code for the services performed during a visit, after the claim has been submitted to a payer, the system automatically generates and sends a task to the biller. Use the instructions below to rework the claim.

Diagnosis Code Change

  1. From the Task tab, locate the system generated task. The Requested Action column says Documentation Changed on Submitted Claims.
  2. Double-click the claim number in Task Details to open the Claim Editor.

    Note: You can also open the Claim Editor by selecting the Claims tab, locate the claim and double-click the claim number. Or use the Accounts tab to locate the patient and select the claim.

  3. Click the Edit column to open the Enter Charges window.
  4. Click the Diagnosis column and select the diagnosis code that needs to change.
  5. Select Commit. The Enter Charges window closes and you are returned to the Claim Editor.
  6. Optional: If you need to resubmit the claim, select Resubmit from the Action column.
  7. Click Save & Close to return to the Claims tab. The Claim Version Note window displays so you can enter a brief explanation about why you are resubmitting the claim.

CPT Code Change

  1. From the Task tab, locate the system generated task. The Requested Action column says Documentation Changed on Submitted Claims.
  2. Double click the claim number in Task Details to open the Claim Editor.

    Note: You can also open the Claim Editor by selecting the Claims tab, locate the claim and double-click the claim number. Or use the Accounts tab to locate the patient and select the claim.

  3. Select the row with the old CPT code and select Void from the Action column.
  4. Click Save.
  5. Click the Edit column to open the Enter Charges window.
  6. Click Add to add a line at the bottom of the list of CPT codes.
  7. Select the new CPT code and the number of units. The Amount column automatically populates with the correct charge amount based on your selection.
  8. Select Commit. The Enter Charges window closes and you are returned to the Claim Editor. The claim is now set to Billable status.
  9. Click Save & Close to return to the Claims tab. The Claim Version Note window displays so you can enter a brief explanation about why you are resubmitting the claim.

Related Links:

Top 10 Reasons a Claim is Denied

Claim Processing Overview

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