Knowledge Base > Biller > Claims Follow-Up > Claims Rework Due to Treatment or Diagnosis Code Changes
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
- From the Task tab, locate the system generated task. The Requested Action column says Documentation Changed on Submitted Claims.
- 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.
- Click the Edit column to open the Enter Charges window.
- Click the Diagnosis column and select the diagnosis code that needs to change.
- Select Commit. The Enter Charges window closes and you are returned to the Claim Editor.
- Optional: If you need to resubmit the claim, select Resubmit from the Action column.
- 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
- From the Task tab, locate the system generated task. The Requested Action column says Documentation Changed on Submitted Claims.
- 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.
- Select the row with the old CPT code and select Void from the Action column.
- Click Save.
- Click the Edit column to open the Enter Charges window.
- Click Add to add a line at the bottom of the list of CPT codes.
- Select the new CPT code and the number of units. The Amount column automatically populates with the correct charge amount based on your selection.
- Select Commit. The Enter Charges window closes and you are returned to the Claim Editor. The claim is now set to Billable status.
- 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.
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