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Medical necessity is one of the top two reasons for Medicare denial and repayment. If a therapist selects "knee pain" instead of "left knee pain", it lacks specificity which may lead to a denial or repayment if medical necessity is not met. If an ICD code alert or notification like "are you sure you want to select this general/unspecific diagnosis?" that would urge the therapist and call attention to a potential medical necessity compliance issue.
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Hello, and thanks for your feedback! Providing alerts for ICD-10 specificity is not a feature we have planned but might consider in the future. We’ll make sure to let you know if this feature is delivered.
In the meantime, if you have any further questions feel free to comment or contact WebPT Support using support@webpt.com.
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