Wiki lab work not covered

Create Wiki
C

CatchTheWind

Guest
Messages
649
Location
Boca Raton, FL
Best answers
0
Our doctors sometimes send patients for blood work because the patient has itching all over with no obvious cause, and so they want to rule out thyroid, liver, and other systemic diseases. But since the primary diagnosis is "pruritis," these tests are not covered.

Does anyone know how we can order these tests using diagnosis of what the doctor is trying to rule out, rather than the symptoms?

Thanks!
 
Is that allowed? I was taught "rule out" cannot be used for diagnosis coding - that if the provider does not know what the presumed diagnosis is, you have to code the symptoms instead.
 
You cannot use the 'rule out' diagnosis in this situation. Hospitals can use this for coding of inpatient facility claims only. For physicians, labs, and all other outpatient services, you cannot use a rule out or suspected diagnosis - this is per the ICD-10 guidelines. If the lab test is not covered due to the diagnosis that the patient has been given, then it needs to be appealed or billed to the patient, not recoded with incorrect information. Keep the coding and coverage issues separate.
 
You must log in or register to reply here.
Top