Wiki Diagnosing a patient without the approval of a physician or clinician

[smors1]

We code for prenatal genetic testing. When a lab requisition is received bearing a screening DX code, and the patient is advanced maternal age (>= 35 years old at EDD), coders contact the provider in order to obtain approval to add an AMA pregnancy supervision code. Our employer has directed us to post the AMA code based on the facts of the pregnancy (gestational age and gravida) without the approval of the provider. It is the coders' opinion that this goes beyond our purview and we are not prepared to do so. Can we have an opinion from your coding experts on this question?

 

[fwnewbie]

That's a sticky one, but it's not like you're taking a hemoglobin reading and coding "anemia". You have the maternal age on the chart and according to the ICD, anyone 35 or over is considered "advanced" so you're just using the reported age and matching it to the term "advanced age". Does the AMA code enhance the likelihood of reimbursement or in any way affect the amount of reimbursement, or is it "telling the story" of the patient's situation?

 

[SharonCollachi]

I would probably send a letter to the referring doctors telling them you will be adding the code in the future to the appropriate claims, should their (the referring doctor's) staff fail to do so.