All you require is to report signs as well as symptoms when diagnostics come back normal.
You consider that you may have aced most ICD-9 challenges, however do you aware with how to manage a diagnostic test which comes back without a final diagnosis? Once you make sure to convey to payers precisely what you found, you'll come out of these challenges. Here are guaranteed ways how to do that and the related ICD-9-CM guidelines.
Follow 3 Rules for Normal Diagnostics Results
Scenario 1: The gastroenterologist refers a patient to a radiologist for an abdominal CT scan (74150-74170) with an indication of abdominal pain (789.0). The CT scan, when read by the GI, discloses the occurrence of an abscess. Both the radiologist -- while reporting for the technical part of the CT scan, along with the gastroenterologist -- when reporting for the professional component of the same test, must report a diagnosis which is "intra-abdominal abscess" (567.22, Peritoneal abscess).
Challenge: What are you supposed to do in case the diagnostics came out normal?
Beware of three different rules:
Rule 1: ICD-9-CM guidelines state that in case the diagnostic test did not deliver a conclusive diagnosis or came out normal consequences, you must code the sign and symptom that encouraged the treating physician to order the study. Roughly, in the preceding scenario, the CT scan results came back minus any abnormal findings, at that time you would report the symptom 789.0 (Abdominal pain) in place of 567.22.
Rule 2: In case the diagnostic test was normal, however the referring physician accounts a suspected (a.k.a. probable, suspected, questionable, rule out, or working) diagnosis, you must not code the referring diagnosis. In its place, you must report the presenting signs and symptoms, according to ICD-9-CM guidelines.
Rule 3: In case the patient is getting only diagnostic services in the outpatient visit, you would list first the condition that is the chief reason for the visit on the claim. According to ICD-9-CM guidelines, this code must be your primary diagnosis. After that, code for further diagnoses (such as chronic conditions) on the following lines.
Tackle This Chronic Condition Scenario
Scenario 2: A patient already diagnosed with liver cancer came to the gastroenterologist for esophageal varices. On the first line of your claim, you would list 456.1 (Esophageal varices without bleeding) for the presenting problem (varices), and after that report 155.0 (Malignant neoplasm of liver primary) meant for the chronic disease (hepatocellular carcinoma).
Challenge: Are you supposed to report the chronic condition?
ICD-9-CM guidelines maintain that you should not code the chronic condition in case it is not related to the primary reason for the visit. For example, the liver cancer patient in Example 2 comes with dyspepsia, you should code only 536.8 (Dyspepsia and other specified disorders of function of stomach), and never 155.0.
You consider that you may have aced most ICD-9 challenges, however do you aware with how to manage a diagnostic test which comes back without a final diagnosis? Once you make sure to convey to payers precisely what you found, you'll come out of these challenges. Here are guaranteed ways how to do that and the related ICD-9-CM guidelines.
Follow 3 Rules for Normal Diagnostics Results
Scenario 1: The gastroenterologist refers a patient to a radiologist for an abdominal CT scan (74150-74170) with an indication of abdominal pain (789.0). The CT scan, when read by the GI, discloses the occurrence of an abscess. Both the radiologist -- while reporting for the technical part of the CT scan, along with the gastroenterologist -- when reporting for the professional component of the same test, must report a diagnosis which is "intra-abdominal abscess" (567.22, Peritoneal abscess).
Challenge: What are you supposed to do in case the diagnostics came out normal?
Beware of three different rules:
Rule 1: ICD-9-CM guidelines state that in case the diagnostic test did not deliver a conclusive diagnosis or came out normal consequences, you must code the sign and symptom that encouraged the treating physician to order the study. Roughly, in the preceding scenario, the CT scan results came back minus any abnormal findings, at that time you would report the symptom 789.0 (Abdominal pain) in place of 567.22.
Rule 2: In case the diagnostic test was normal, however the referring physician accounts a suspected (a.k.a. probable, suspected, questionable, rule out, or working) diagnosis, you must not code the referring diagnosis. In its place, you must report the presenting signs and symptoms, according to ICD-9-CM guidelines.
Rule 3: In case the patient is getting only diagnostic services in the outpatient visit, you would list first the condition that is the chief reason for the visit on the claim. According to ICD-9-CM guidelines, this code must be your primary diagnosis. After that, code for further diagnoses (such as chronic conditions) on the following lines.
Tackle This Chronic Condition Scenario
Scenario 2: A patient already diagnosed with liver cancer came to the gastroenterologist for esophageal varices. On the first line of your claim, you would list 456.1 (Esophageal varices without bleeding) for the presenting problem (varices), and after that report 155.0 (Malignant neoplasm of liver primary) meant for the chronic disease (hepatocellular carcinoma).
Challenge: Are you supposed to report the chronic condition?
ICD-9-CM guidelines maintain that you should not code the chronic condition in case it is not related to the primary reason for the visit. For example, the liver cancer patient in Example 2 comes with dyspepsia, you should code only 536.8 (Dyspepsia and other specified disorders of function of stomach), and never 155.0.
No comments:
Post a Comment