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I have a quick question about coding compliance. I work for a Lab and I was wondering if we can used an old diagnosis code that provided from the doctor in a previous DOS in our current DOS if it not a systematic disease? For example, if the doctor provide E55.9 as a Dx and he want to check for Vit D and 2 month from that day he want to check for Vit D again but provided with a different Dx that I know Medicare will denial. Reviewing the test result, Vit D was normal. My question is can I used E55.9 from a previous DOS to code for the new DOS? I don't think we can but to prove to my supervisor that I was right, can someone help me with backup document or any advice on a similar situation like this one pleasssssse?


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Here's a section from Chapter 16 of the Medicare Claims Processing Manual that addresses this:

Section 4317 of the Balanced Budget Act of 1997 provides, with respect to diagnostic laboratory and certain other services, that “if the Secretary (or A/B MAC (A) or (B) of the Secretary) requires the entity furnishing the services to provide diagnostic or other medical information to the entity, the physician or practitioner ordering the service shall provide that information to the entity at the time the service is ordered by the physician or practitioner.” A laboratory or other provider must report on a claim for Medicare payment the diagnostic code(s) furnished by the ordering physician. In the absence of such coding information, the laboratory or other provider may determine the appropriate diagnostic code based on the ordering physician’s narrative diagnostic statement or seek diagnostic information from the ordering physician/practitioner. However, a laboratory or other provider may not report on a claim for Medicare payment a diagnosis code in the absence of physician-supplied diagnostic information supporting such code.

I think it sums it up pretty well that the diagnosis you use has to be tied to the physician's order for the particular lab test and can't be pulled from the patient's history. Hope this may help some.