|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.
Viewed 2043 times since Tue, Apr 12, 2011
Sarcoidosis Metastatic to Bone
Viewed 1117 times since Mon, Jun 27, 2011
Upper GI Bleed Secondary to Erosive Esophagitis
Viewed 4368 times since Wed, Nov 17, 2010
Echocardiogram Prior to Chemo
Viewed 3725 times since Tue, Jun 7, 2011
Lesion Removal Coding
Viewed 2073 times since Wed, Mar 23, 2011
SBO with Bezoar
Viewed 508 times since Wed, Jan 9, 2013
Versus Or Contrasting/Comparative Diagnosis
Viewed 1117 times since Thu, Oct 27, 2011
Viewed 1017 times since Fri, May 6, 2011
Principal Diagnosis Assignment on ED Patient
Viewed 1208 times since Mon, Oct 10, 2011
Age range on Radiology Examination
Viewed 9732 times since Wed, Jun 15, 2011