Wiki Rad scheduler tells Dr what ICD code to use

Birdie625

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I hope I explain this clearly - This is not my area of understanding/knowledge. Scenario in question is:

I saw recently: I 'think' test was for CT scan/brain (I dont recall)
Order said Reason: R/O Stroke / DX = G93.89.
Modified order now showed: Reason R/O Stroke // DX = G93.89 & I63.9....Order re-signed by Dr.

I was told (and thought): Dr re-signed order --- all was good for claim

When I tracked the modified changes, I saw the Rad Scheduler told Dr the G93.89 was 'not on list' and to add dx of "cardiac issue" (which was I63.9...the apparently R/O condition)

I think the final claim (I didn't see) on UB was: Reason = G93.89 // DX = G93.89 / I63.9

This scenario seems wrong to me. I wanted to bring to a supervisor's attention, but wasn't sure which direction to go (Rad dept / Provider / Compliance). And heck, "maybe" Im just over-thinking.

My thinking is the Reason should have been sign/symptoms (of a stroke) / DX same along w/G93.89 …. "unless" the Rad Final Report, then instead of s/s code the final, but if Normal, keep s/s.
I personally think the workflow for the Laboratory / Radiology department charges is flawed. I don't know what suggestions to make and/or how I can help to better such.
Any comments and/or links to search on such would be appreciated. Thanks much. Birdie
 
HI, "not on the list" is very vague. Is this an LCD/NCD diagnosis "list" they are referring to, as an LCD would show medical necessity for certain procedure codes. Or is this an intake process for the RAD dept?

My first question would be why is this patient getting Radiology (medical necessity)? A diagnosis cannot just be added or changed to get payment? If the patient needed a Rad procedure due to a stroke then that is what should be on the claim (maybe a more specified dx). Was a prior auth needed and that is why it was changed?

A diagnosis of brain vs. heart is very different? What is the procedure code that they are referring to? and what is your question to the claim in question? was it denied or is it a question of miscommunication?

Thanks :)
 
Hi -- I reviewed situation:
1) Test was 93306 - US Echo (my first post wasn't certain of test)-- Rad scheduler message was: "G93.89 is not on the Medicare approved list for Echocardiograms. Please add to the order a ICD10 code that is for cardiac issue." (Pt has neither Medicare or Medicaid type ins) ***"MY" thinking is that....IF ruling out cardiac issue, how can it be a diagnosis used???****
2) Dr modified her Order to read: Reason I63.9 // DX = I63.9 / G93.89
3) UB Claim set to go out w/above
My question/concern was upon seeing the Rad scheduler telling provider a dx is not on a list (I am 'assuming' a Med Nec list, but I'm not certain) that the provider who originally ordered the test for a Rule Out (stroke) would then just "give" that patient that dx w/o it being confirmed. Having seen what I've seen in this situation, just seemed very "odd" the Rad Scheduler would tell a Dr to put a different dx...and then the Dr doing such.
It was just ODD to me and again, maybe I am just going somewhere I don't belong. Thanks much....
 
NO, I completely agree with you. That is weird, and a patient's diagnosis should not come from a list, it should come from a doctors documentation. I would think that the reason he ordered the ECHO is to rule out any clots in the heart, that may have caused the stroke. Then the conclusion of DX code I63.9 would be what the provider found if that is the case?
I really don't have all the information, so it is hard to determine a definitive answer.

If you have anymore questions don't hesitate to reach out. Have a great day.
 
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