|Home » Categories » ICD-9-CM Coding|
Admit and Reason for Visit Codes
|Article Number: 581 | Rating: Unrated | Last Updated: Fri, Apr 20, 2012 8:54 AM|
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.
There are no attachments for this article.
There are no comments for this article. Be the first to post a comment.
Lack of Normal Physiological Development
Viewed 1206 times since Wed, Oct 26, 2011
Viewed 659 times since Wed, Aug 3, 2011
Screening vs Diagnostic Colonoscopy
Viewed 157 times since Wed, May 4, 2011
Borderline Serous Ovarian Tumor
Viewed 2721 times since Tue, Jun 14, 2011
Abdominal Pain Versus Pelvic Pain
Viewed 2998 times since Thu, Mar 31, 2011
Acute Lumbar Back Pain
Viewed 1027 times since Thu, Feb 23, 2012
Viewed 1670 times since Tue, May 24, 2011
Viewed 2176 times since Mon, Apr 11, 2011
Pap Smear ICD-9 Coding
Viewed 1304 times since Fri, May 4, 2012
Poor Venous Access
Viewed 2332 times since Wed, Dec 14, 2011