Question

The patient underwent a blood glucose test, and the provider documented type 2 diabetes mellitus in the patient record the coder assigned a copy code to blood glucose test and an ice 10 cm code type 2 diabetes mellitus the health insurance company reviewed the submitted claim and determine that support of medical necessity was evident. Should the insurance company reimburse the provider for this encounter? If yes why if no why not ?

Answer 1

The insurance company should reimburse the provider for the encounter because the medical necessity is substantiated by the blood glucose test and type 2 diabetes mellitus diagnosis, all of which were properly coded using the ICD-10-CM system.

Step-by-step explanation:

Yes, the insurance company should reimburse the provider for this encounter. The documentation provided by the provider, including the blood glucose test results and the diagnosis of type 2 diabetes mellitus, supports the medical necessity for the encounter.

ICD-10-CM codes were correctly assigned to both the blood glucose test and the diagnosis of type 2 diabetes, as per standard medical coding practices.

The clear link between the conducted tests and the confirmed diagnosis justifies the reimbursement. Medical necessity is proven by the diagnosis of hyperglycemia, the cornerstone in diagnosing diabetes, and the subsequent need for a specific type of diabetes determination.

The Glucose Tolerance Test (GTT), Insulin Tolerance Test (ITT), and Glucagon Tolerance Test (GuTT) are relevant here as they are used to confirm diabetes mellitus and distinguish between insulin-dependent or independent diabetes cases.

Type 2 diabetes often entails insulin resistance, and accurate coding and documentation are crucial in ensuring proper treatment and billing procedures.