Home » Categories » ICD-9-CM Coding

Admit and Reason for Visit Codes


Question

On outpatient labs/x-rays, if a more definitive diagnosis is found on an x-ray and coded as principal, wouldn’t you use the diagnosis on the doctor’s order for the admit/reason for visit code? Some payers question medical necessity without it. Also it is the diagnosis on the order that is scrubbed for an ABN, not the final result on an x-ray. Does Medicare/Medicaid look at an admit/reason for visit code at all?

Answer

It is my understanding that the only time Medicare recognizes the admitting diagnosis on an outpatient claim is for an emergency room visit.  The diagnosis provided by the physician on the order for the outpatient test should be submitted as one of the final diagnoses.  While the results of a physician interpreted report may be used in the outpatient coding process, caution should be used as the coding guideline is that incidental findings on these reports should not be coded.  It may be difficult for the coder to make the distinction between an incidental finding and one that should be coded.  For outpatient ancillary coding purposes, if the provided diagnosis meets medical necessity, there is no need to refer to the interpreted report for additional diagnoses.  A valid use for referring to the results of an interpreted report when coding ancillary outpatient records is if the physician has provided a rule out diagnosis that needs to be verify since we can not code a rule out diagnosis on an outpatient claim or a fracture diagnosis where the report may provide the actual site of the fracture.  

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
Attachments Attachments
There are no attachments for this article.
Related Articles RSS Feed
Sepsis secondary to line infection and pneumonia
Viewed 4986 times since Tue, Dec 27, 2011
Which of Two Diagnosis Would be Principal?
Viewed 2180 times since Tue, Aug 28, 2012
Sinobronchial Syndrome
Viewed 5483 times since Mon, Apr 25, 2011
ICD-9 code Periampullary diverticulum
Viewed 6591 times since Tue, Sep 20, 2011
Echocardiogram Prior to Chemo
Viewed 7172 times since Tue, Jun 7, 2011
Anemia of Chronic Disease
Viewed 1793 times since Thu, Sep 15, 2011
Sun Poisoning
Viewed 2043 times since Thu, Jul 28, 2011
Influenza A
Viewed 3931 times since Fri, Feb 18, 2011
Medicare Screening Vaginal Pap Smear
Viewed 9539 times since Tue, May 3, 2011
Rhomboid Sprain Diagnosis
Viewed 4370 times since Fri, Dec 16, 2011
Quorum Health Resources, LLC :: 105 Continental Place Brentwood, TN 37027 :: Phone: (615) 371-4506