Wiki Echo coding

heartyoga

Guru
Messages
154
Location
Cookeville
Best answers
0
We are following guidelines on billing echocardiogram based on results. E.g. mild mitral insufficiency (I34.0), mild aortic insufficiency (I35.1).

However, if patient has indications that makes the echocardiogram medically necessary, e.g. shortness of breath, murmur, CHF, etc.. doesn't it make a stronger case to code the indications rather than the "mild" results?

We usually code both the indications and results but technically which one would make it "more" correct in the eyes of Medicare and other insurances?

Thanks!
 
As long as your result diagnosis is covered by the LCD for echocardiography, I've never found it necessary to include the indications. The findings and interpretation by the physician are what should really be reported.
This way you are also following the ICD-10 guidelines of reporting the definitive diagnosis and not "signs and symptoms". Mild results are no less valid than findings that are moderate or severe. Bottom line, the patient has the condition.
I hope this helps :D
 
Thanks

Thanks for your clarification. We just kinda feel bad "tagging" patient with mild results since as our doctor has explained almost 100% of elderly population have mild mitral insufficiency but it is not significant medically. He is worried that if audited the indications are more valid to support why the echo was performed (ICD9 guidelines). I have explained that ICD10 now requires us to code the results and if results are normal, to use the indications. He wants us to use both the results and the indications.
 
Top