Neurology & Pain Management Coding Alert

You should never report an unconfirmed diagnosis to justify billing diagnostic tests (or any other procedure or service). This constitutes fraudulent coding and places your patients at risk.
 
If you use an unconfirmed diagnosis, you're unfairly labeling patients as having a condition that they may not have. Insurers maintain databases of all these codes, and if the patient later applies for life, health or disability insurance, the insurance company will look for any problems he or she may have had in the past and may deny or charge more for coverage based on false information in the medical record.
 
Just as significant, reporting a diagnosis that does not exist just so your neurologist can receive compensation is out-and-out fraud and could lead to fines and even imprisonment. Although you may report post-test diagnoses if they are present, you should rely on signs and symptoms codes to justify all services if the patient does not have a confirmed condition. For instance, if the patient has carpal tunnel signs and symptoms, but testing does not confirm the diagnosis, the insurer will still pay for the testing based on the signs and symptoms. You cannot claim a diagnosis of carpal tunnel if it is not present, just to receive payment.
 
If the signs and symptoms the physician documents do not justify the services he or she provides, chances are the services are not reasonable and necessary.