Code Justify

Updated by Steven Garand

Justifications are used to generate a recommended Letters Of Medical Necessity (LMN) the doctor can modify and sign. When an items on order forms are chosen, the associated justifications are used to to generate the letter.
Justifications are associated with codes.
Many justifications can be associated with a single code.
K0108 codes are further broken out into categories.
Use the HCPCS tab to enter justifications for a particular code.
Use the K0108 tab to enter justifications for a particular K0108 category.
Use the All tab to enter similar justifications across different codes. Note that each justification will still need a separate row.
Justifications can include placeholders such as ~patientFirst~ and ~patientLast~ replaced with the patients first and last name when the LMN is generated. For a complete list of placeholders see the Justification section below.
Add your set of justifications that works best for your payers and what they are looking for. The system has a default set of justifications to use as examples but taking the time to update the justifications that best work for your situation is well worth the effort.
Use the All tab to clean up justifications.

Justification Options

  1. Justification
    1. The text used to build the LMN.
    2. Can be up to 8000 characters.
    3. If more than 8000 characters required, create multiple justifications.
    4. Placeholders can be entered into the text which will be replaced with the appropriate values when an LMN is generated. Please note the placeholder will appear in the justification section of the line items but will be replaced when an LMN is generated.
      1. ~patientFirst~
      2. ~patientLast~
      3. ~his/her~
      4. ~him/her~
      5. ~he/she~
      6. ~Mr./Ms.~
      7. ~His/Her~
      8. ~Him/Her~
      9. ~He/She~
  2. Default (Def)
    1. If checked the justification defaults to being added to the LMN.
    2. If unchecked the justification is not automatically added to the LMN.
    3. The user can over ride this value for a particular order before generating the LMN.
  3. Sort#
    1. Determines the order the justifications appear.
    2. Applies only to the justifications for a particular code.
  4. Qualify ICD10
    1. Determines if the justification defaults to being added to the LMN based on the ICD code specified on an a line item.
    2. If the Qualify ICD code matches the line item ICD code, the justification is set as a default and automatically added to the LMN.

Actions

  1. Add new justification *
  2. Delete justification
  3. Update justification *
  4. View justifications for a code
  5. Save justification changes
  6. Sort justifications
  7. Move justification columns
  8. Filter justification

* Row denied if justification is blank or in All tab if Code is not 5 characters, or if K0108 category specified and Code is not K0108.

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