Home » Categories » ICD-9-CM Coding

Admit and Reason for Visit Codes


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?


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
History of HTN
Viewed 2682 times since Thu, Jul 7, 2011
S/P Stent Placement
Viewed 25768 times since Wed, Jun 22, 2011
Respiratory Arrest
Viewed 7104 times since Fri, Apr 22, 2011
Laparoscopic Hysterectomies
Viewed 1790 times since Thu, Apr 7, 2011
Principal Diagnosis Assignment on ED Patient
Viewed 1695 times since Mon, Oct 10, 2011
Coding from Radiology Report-Clarification
Viewed 2975 times since Thu, May 19, 2011
Viewed 1373 times since Wed, May 11, 2011
Elevated Liver Function Test
Viewed 16101 times since Wed, Nov 17, 2010
Localized Sepsis
Viewed 3323 times since Wed, Nov 17, 2010
Anemia of Chronic Disease
Viewed 1836 times since Thu, Sep 15, 2011
Quorum Health Resources, LLC :: 105 Continental Place Brentwood, TN 37027 :: Phone: (615) 371-4506