Wiki Question about a diagnosis

AMCROOK

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Say we have a patient come in for a low T visit. The physician runs a PSA and Total T test on him. Diagnosis on this particular visit comes back as hypogonadism and that’s the only diagnosis the physician puts in his dictation. Some insurances will not cover a PSA test for hypogonadism. Am I able to look back in his record for a covered diagnosis for the PSA? For instance we saw him last year and he had BPH but the doctor did not list that this time.

Thanks so much!
 
Hello,

No you cannot go back to a previous encounter to pull a diagnosis to support a lab done for a potentially not covered condition. You must code the condition for which the provider ordered which in this situation is Hypogonadism.
 
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