Wiki Professional Ultrasound Billing in an Office Setting

[avacchelli]

Maternal Fetal Medicine. When coding an ultrasounds I have the following questions:

1. Does the "test indications" section need to be specific to the actual condition? i.e. You know a patient is HIV positive but you use the term "maternal infectious disease" on the report and the provider choices the electronic record to state HIV Z21.

2. Does the dx on the report need to match the claim sent to insurance carriers exactly? Again, HIV on the claim that goes out to insurance - Infectious disease indicated on the on the report no mention of HIV.

3. POS 11-Office are you allowed to code from the entire patient record or does the report need to the only source to code from.

4. If you can review that patients entire record and find an existing condition like HIV code it without amending the report if there is no other specific dx (same as question 1 basically but coder finding not provider dx choosing)

 

[AmandaBriggs]

I would recommend reading the ICD-10-CM Official Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services.
1. The "test indications" should match the reason for the study from the order signed by the provider.
2. Yes, the diagnoses on the report should match the claim sent to the payer. If infectious disease is on the report and is not specified as HIV anywhere within the report then you may not report the HIV as the documentation does not support it. Remember, if the payer requests the documentation, they will likely only be receiving the diagnostic report, the order, and maybe the E/M note that prompted the service.
3. POS 11 - you may not code from the entire record, only the report that is in front of you. The exception to this would be a biopsy that is sent for pathology - you would wait for the pathology report to come back and code the definitive dx.
4. If patient has HIV, then the report would need to be amended to reflect that specificity

 

[avacchelli]

I would recommend reading the ICD-10-CM Official Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services.
1. The "test indications" should match the reason for the study from the order signed by the provider.
2. Yes, the diagnoses on the report should match the claim sent to the payer. If infectious disease is on the report and is not specified as HIV anywhere within the report then you may not report the HIV as the documentation does not support it. Remember, if the payer requests the documentation, they will likely only be receiving the diagnostic report, the order, and maybe the E/M note that prompted the service.
3. POS 11 - you may not code from the entire record, only the report that is in front of you. The exception to this would be a biopsy that is sent for pathology - you would wait for the pathology report to come back and code the definitive dx.
4. If patient has HIV, then the report would need to be amended to reflect that specificity

Thank you for that!

 

[avacchelli]

I would recommend reading the ICD-10-CM Official Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services.
1. The "test indications" should match the reason for the study from the order signed by the provider.
2. Yes, the diagnoses on the report should match the claim sent to the payer. If infectious disease is on the report and is not specified as HIV anywhere within the report then you may not report the HIV as the documentation does not support it. Remember, if the payer requests the documentation, they will likely only be receiving the diagnostic report, the order, and maybe the E/M note that prompted the service.
3. POS 11 - you may not code from the entire record, only the report that is in front of you. The exception to this would be a biopsy that is sent for pathology - you would wait for the pathology report to come back and code the definitive dx.
4. If patient has HIV, then the report would need to be amended to reflect that specificity

One last question. Would this logic also apply to place of service 19?