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CandyHershel

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Okay need some help....

Scenario 1:

Patient comes to doctor's office for right ankle pain. The doctor suspects a fracture but cannot confirm until an X-ray is done. DOS is 9/1/2015. X-ray performed 9/2/2015. X-rays confirm fracture. The doctor wants to use the fracture diagnosis for the 9/1/2015 visit. Since X-rays were not done until the day after shouldn't the doctor code right ankle pain for the 9/1/2015 visit instead of the fracture dx??


Scenario 2:

Patient suspects possible UTI. UA is done in office and it produces abnormal results. Specimen is sent to lab for culture to confirm UTI. We should code highest level that is confirmed. Since the UTI is not confirmed we would code signs, symptoms, and abnormal UA?

Thanks
 
If he puts the fracture diagnosis on the 9/1 visit there is less medical necessity for the x-ray. Second scenario as well.
 
CandyHershel said:
Okay need some help....

Scenario 1:

Patient comes to doctor's office for right ankle pain. The doctor suspects a fracture but cannot confirm until an X-ray is done. DOS is 9/1/2015. X-ray performed 9/2/2015. X-rays confirm fracture. The doctor wants to use the fracture diagnosis for the 9/1/2015 visit. Since X-rays were not done until the day after shouldn't the doctor code right ankle pain for the 9/1/2015 visit instead of the fracture dx??


Scenario 2:

Patient suspects possible UTI. UA is done in office and it produces abnormal results. Specimen is sent to lab for culture to confirm UTI. We should code highest level that is confirmed. Since the UTI is not confirmed we would code signs, symptoms, and abnormal UA?

Thanks
Click to expand...

When there is no definitive diagnosis signs and symptoms must be used. :)
 
It is all very dependent on how the provider documented this. In the case of the fracture, the provider will not know it us fractured without the radiology report so you use the symptoms since the radiology was not performd until the next day. In the case of the UTI, if the provider documents a UTI then that is how it is codes since the provider is not required to perform any studies to determine the presence of the infection. However if the provider documents possible or suspected UTI then you use the symptoms.
 
I agree, it removes medical necessity for having the x-ray in the first place. Thank you all for making me feel not so crazy trying to get this point across:D
 
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