Wiki Lab changing diagnoses

[robersonjen]

Does anyone know the repercussions of a lab changing ICD-10 codes from the ordering physician's order to get claims paid?

 

[thomas7331]

The repercussion is that if the lab is audited and the documentation (e.g. the physician orders and/or the provider's assessment and rationale for ordering the labs in the patient's medical record) does not support the diagnosis on the claim, the lab may be subject to recoveries of any overpayments as well as potential sanctions for submission of false claims and/or penalties for violation of contracts with payers.