What should a coding professional do if a CT scan claim is denied due to missing a headache diagnosis?

When a CT scan claim is denied because a headache diagnosis is missing, the most appropriate course of action is to add the headache diagnosis and resubmit the claim. This approach directly addresses the reason for the denial by ensuring that all relevant diagnoses are included, which is essential for proper coding and reimbursement.

In this scenario, including the headache diagnosis provides the necessary justification for the medical necessity of the CT scan. Claims must be complete and accurate, reflecting all pertinent diagnoses that support the services provided. By correcting the claim in this manner, the coding professional enhances the likelihood of reimbursement while ensuring compliance with coding guidelines.

Other options, such as ignoring the denial, changing to a different diagnosis, or appealing directly to the insurance company without first correcting the initial claim, do not effectively resolve the underlying issue. Ignoring the denial would not rectify the problem and could lead to further complications in reimbursement. Changing the diagnosis to something unrelated might misrepresent the patient's condition and could violate coding guidelines. Appealing without correcting the claim also overlooks the standard procedure, which typically involves addressing the specific reasons for the denial before taking further action.