What is Necessary for Reporting the Diagnosis in the Demand Letter?
For a demand letter, you need to have the following for every injury sustained by the client:
- A short text description of the diagnosis (e.g. “Lumbar Disc Protrusion L4-5”)
- The ICD-10 Code
- Diagnosing Doctor
- Date of the initial diagnosis
Over the past 20 years, we’ve seen a number of problems with accomplishing this rather obvious requirement of a demand letter.How ICD Codes Impact Economic Damages: Insurers almost always use a separate software system or review service for the past medical bills (economic damages) than they do for the determination of economic damages. These programs review multiple aspects of the client's treatment in light of the diagnoses, and substantially reduce what the insurer then deems to be "reasonable and necessary" charges.
The basics are this: over time, insurers started to use ICD diagnosis codes to their advantage as a way to track and limit payments to health care providers. Sometimes, they even limit the amount of treatment deemed to be “reasonable and necessary” for a patient based solely upon the ICD codes listed on the billings. This makes the doctor’s ability to code fully, and correctly, very important to your settlement offers.