If an outpatient laboratory claim fails an edit due to a diagnosis code issue, what action would not be appropriate to resolve the edit?

Submitting the claim without modifications is not an appropriate action to resolve a diagnosis code issue that caused the claim to fail an edit. In the revenue cycle and billing processes, it is essential to ensure that all information included in a claim is accurate and adheres to the required coding standards. This includes the diagnosis codes, which must accurately reflect the patient’s condition as documented in their medical record.

When a claim fails due to a diagnosis code issue, there are several proactive steps that should be taken, such as reviewing and correcting any coding errors or consulting with the provider for clarification on the accurate diagnosis. These actions help to ensure that the claim can be successfully processed and reimbursed. However, simply resubmitting the claim without making any changes or addressing the underlying issue does not align with best practices in the revenue cycle management. Neglecting to make necessary corrections would likely result in repeated denials and delays in payment.