1formissy
Guru
I am seeking information regarding claims that are audited for professional services. My scenario is this.
The provider is reading a radiology report, and does not document on that particular report, a sign/symptom, nor a diagnosis for the test that was done.
As a professional auditor, it has always been my understanding that if the document that is pertinent to that service date that is reported does not have a diagnosis or sign/symptom on that particular report, you cannot bill the charges.
However, I was provided the information from fellow coders that if there is no diagnosis/sign/symptom on that particular reading report, you can pull a diagnosis from the patient's CHART to bill the claim.
I am attempting to clarify this issue by researching on CMS website, however, I am not able to obtain the information I am looking for.
I would really appreciate if someone could point me to the direction to where this would be clarified.
The provider is reading a radiology report, and does not document on that particular report, a sign/symptom, nor a diagnosis for the test that was done.
As a professional auditor, it has always been my understanding that if the document that is pertinent to that service date that is reported does not have a diagnosis or sign/symptom on that particular report, you cannot bill the charges.
However, I was provided the information from fellow coders that if there is no diagnosis/sign/symptom on that particular reading report, you can pull a diagnosis from the patient's CHART to bill the claim.
I am attempting to clarify this issue by researching on CMS website, however, I am not able to obtain the information I am looking for.
I would really appreciate if someone could point me to the direction to where this would be clarified.