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diagnosis on lab orders

abranch13

Networker
Messages
55
Location
Kansas City, MO
Best answers
0
I am trying to find some documentation stating lab orders need to be billed with the diagnosis the provider has indicated for that test for the current visit. I need this to educate providers that the coder cannot change the diagnosis code from what the provider has indicated to get the charge paid, and that if a change does need to be made the provider needs to make an amendment in the pts records. I am having a hard time finding this in writing......anyone know where I can find this?

Thanks
 

mitchellde

True Blue
Messages
13,291
Location
Columbia, MO
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0
we bill from the documentation not what it takes to get the claim paid. The coder should always obtain the codes for any service from a review of the documentation.
 

abranch13

Networker
Messages
55
Location
Kansas City, MO
Best answers
0
I agree with coding from the documentation or orders....I just need some documentation to prove my point :) Specifically for Medicare, do you know where I can obtain this??
 

Kisalyn

Expert
Messages
272
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0
Found this from Medicare's Claims Processing Manual (Chapter 16):

Physicians Reporting Diagnosis Codes When A Diagnostic Test Is Ordered

Section 4317 of the Balanced Budget Act of 1997 provides, with respect to diagnostic laboratory and certain other services, that “if the Secretary (or fiscal agent 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.


http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html
 
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