Does Physician Office have to match Hospital's diagnosis code?

heartyoga

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I work in an independent solo practitioner's office. Our doctor does stress test, echoes for the hospital and we will for the professional component. We have a problem.

The stress test A report reads :

1. moderately enlarged left ventricle with calculated LVEF of 45%
etc etc

Another report B reads:
1. mildly dilated left ventricle with end diastolic volume of 128 mL.

Hospital coded both as cardiomegaly I51.7

We have clarified with our physician and he said the patient A has cardiomyopathy (he has seen this pt in the clinic).


We have had cases where it says,
1. fixed perfusion defect was seen involving mid inferior wall, may be due to attenuation artifact. (hospital coded it as cardiac septal defect).

We are concerned for our patients who gets tagged with cardiomegaly and eventually if they have hypertension coded, we have to code them as hypertensive heart disease. We have had cases of patients coming to our office upset that they cannot obtain life insurance, health insurance, coverage etc. due to having serious heart issues.

My question is :
Does the insurances "match" what the hospital and the doctors code? Because if they do, we won't match well.
We are worried about defending our codes during audits.

Thanks for your advice.
 
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