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
MUGA Scan Prior to Chemotherapy
Viewed 7978 times since Tue, Nov 16, 2010
Poor Venous Access
Viewed 5376 times since Wed, Dec 14, 2011
Viewed 2307 times since Mon, Sep 19, 2011
Outpatient Documentation
Viewed 1331 times since Thu, Jul 19, 2012
Limbic Encephalitis Paraneoplastic Syndrome
Viewed 5294 times since Wed, Jun 15, 2011
Viewed 1303 times since Sat, Nov 26, 2011
Chronically Elevated HCG
Viewed 5454 times since Thu, Apr 21, 2011
Which of Two Diagnosis Would be Principal?
Viewed 2387 times since Tue, Aug 28, 2012
Spine Coding
Viewed 50 times since Wed, Oct 12, 2011
Retrobulbar Hemorrhage
Viewed 6937 times since Fri, Nov 9, 2012
Quorum Health Resources, LLC :: 105 Continental Place Brentwood, TN 37027 :: Phone: (615) 371-4506