I work in a Diagnostic Lab, we get an overwhelming amount of orders for diagnostic tests with diagnosis codes that do not support the medical need for testing. Therefore we are seeing a dramatic loss in revenue on our medicare claims. However, according CMS guidelines we at the lab are not allowed to "add" codes. Being a coder, that's tough because I feel limited in how I can correct the problem and I have a confusing interpretation of the word "add" as it is used.
With that said my questions are as follows:
1.) When CMS states labs can not "add" codes, does this mean that we can never code a charts/medical record that we receive for testing, ever, or does it simply mean that if we do, we are held to the same standard of - "if it isn't documented it didn't happen" - from the physicians notes?
Also, I've notice a lot of our orders come in for a full wellness panel with one diagnosis M54.16. Would M54.16 (Radiculopathy, Lumbar Region) support the medical need for the following CPT codes that are included in our full wellness panels? I have consulted the NCD list of supported ICD-10 codes and it is not listed in the covered or non-covered list of supporting medical necessity which would mean that it is not one covered by medicare, right? Just wanting to clarify to see if my findings are correct or if it would infact be covered...
85025
80053
82533
82627
82670
82728
82746
83001
83036
83003
84305
83520
83970
83540
83550
80061
83002
83735
84144
84146 or 84153
84270
84481
84439
84403
84443
82607
82306
Any help is greatly appreciated!
With that said my questions are as follows:
1.) When CMS states labs can not "add" codes, does this mean that we can never code a charts/medical record that we receive for testing, ever, or does it simply mean that if we do, we are held to the same standard of - "if it isn't documented it didn't happen" - from the physicians notes?
Also, I've notice a lot of our orders come in for a full wellness panel with one diagnosis M54.16. Would M54.16 (Radiculopathy, Lumbar Region) support the medical need for the following CPT codes that are included in our full wellness panels? I have consulted the NCD list of supported ICD-10 codes and it is not listed in the covered or non-covered list of supporting medical necessity which would mean that it is not one covered by medicare, right? Just wanting to clarify to see if my findings are correct or if it would infact be covered...
85025
80053
82533
82627
82670
82728
82746
83001
83036
83003
84305
83520
83970
83540
83550
80061
83002
83735
84144
84146 or 84153
84270
84481
84439
84403
84443
82607
82306
Any help is greatly appreciated!
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