HNS Policy 

 

All diagnoses reported on the insurance claim must be documented in the healthcare record.  

The patient’s healthcare record must reflect ALL diagnosis/clinical impressions. The diagnosis or diagnostic impression must be reasonable based on the patient’s chief complaint(s), results of clinical findings, diagnostic tests and other available information. 

 

If the diagnosis code requires the inclusion of laterality (left/right) the documentation in the health care record must clearly substantiate the laterality reported in the code.

Diagnoses reported on insurance claims must be consistent with HNS and HNS Payor Policies, the policies of applicable licensing boards, as well as state and federal laws.
 

Any changes in diagnoses must be documented in the patient’s healthcare record.

The provider must utilize the ICD codes that appropriately reflect the findings of the clinical examination and support the necessity of care. 

For services billed to a HNS contracted payor, as a general rule, the diagnosis must be related to a neuromusculoskeletal condition and/or the condition must be improved or resolved through standard chiropractic therapy. (See individual payor corporate medical policies for when chiropractic services are covered.)