ambulance compliance

I work for an ambulance company and one of the insurances we send claims to requires the use of condition codes. They will not pay if a condition code from their list is not used. We do a lot of interfacility transports and often have specific dx codes that are not on their condition code list. They will not pay these claims even with an appeal. Now management is considering getting the hospital medical records and seeing if the hospitals have a diagnosis on the condition code list and having the coders change the existing diagnosis before billing the claim.

Clearly I am uncomfortable with this idea. Can someone point me in the right direction? It was my understanding one can only bill for the current episode of care.

I have been all over the OIG website and can not find anything specifically excluding this, but neither can I find anything stating it is ok to do. I know one can use other documentation to support an adverse benefit determination but one is not changing icd9 codes.

Any help would be appreciated

ambulance compliance