Wiki Signs and Symptoms vs Findings

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sandya

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Hi...I would like some clarity on something. We are a cardiology group that reads diagnostic tests in the hospital setting, whether the place of service is inpt, outpt, or even er. The final report is always available to me, therefore, I code by the findings. However, what if the findings are not payable for the test, but the signs and symptoms are. Can you ignore the findings and code the signs and symptoms, or is this "coding to get paid"...I code by the findings and if it's not payable, we try to appeal etc...What do other groups do and what is correct? thank you Sandy:)
 
sandya said:
Hi...I would like some clarity on something. We are a cardiology group that reads diagnostic tests in the hospital setting, whether the place of service is inpt, outpt, or even er. The final report is always available to me, therefore, I code by the findings. However, what if the findings are not payable for the test, but the signs and symptoms are. Can you ignore the findings and code the signs and symptoms, or is this "coding to get paid"...I code by the findings and if it's not payable, we try to appeal etc...What do other groups do and what is correct? thank you Sandy:)
Click to expand...

Here is some good information check out 10.1

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c23.pdf

Also for example on a echo, I cant think of why a finding wouldnt cover the procedure.
Let me rephrase that. Usually if a physician sees a finding not related to what is normally a covered dx for an echo that isnt related to cardiac they will not report it and if they do they will say "incidental finding". And we are not to use incidental findings.

Maybe you can give an example. Its early morning and Im tired!
 
findings vs signs and symptoms

Hi Theresa,
I have an example of a tilt table 93660, the only payable dx is syncope. We have had findings of hypotension or dizziness or orthostatic hypotension. Per the LCD, those dx are not payable. Does this make them incidental because they are not on the LCD and not considered medically necessary? Help!! Thanks Sandy
 
sandya said:
Hi Theresa,
I have an example of a tilt table 93660, the only payable dx is syncope. We have had findings of hypotension or dizziness or orthostatic hypotension. Per the LCD, those dx are not payable. Does this make them incidental because they are not on the LCD and not considered medically necessary? Help!! Thanks Sandy
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Sandy,
The tilt-table test is designed to detect the common causes of fainting or lightheadedness, postural hypotension (orthostatic hypotension). So those diagnosis are not incidential findings. I would go ahead and use the indication as your primary dx. This would not be considered "trying to get the claim paid". Not at all.
 
Hi Theresa,
thanks...if the orthostatic hypotension isn't incidental, then wouldn't I use that as my diagnosis, since it was a finding? We wouldn't get paid, but if it's a true finding and not incidental, why would I then use syncope? thanks Sandy
 
sandya said:
Hi Theresa,
thanks...if the orthostatic hypotension isn't incidental, then wouldn't I use that as my diagnosis, since it was a finding? We wouldn't get paid, but if it's a true finding and not incidental, why would I then use syncope? thanks Sandy
Click to expand...

You are correct in the usual thought use the finding and if the finding is normal go back to the indication as the dx for the test. In this case the finding is not an approved dx so it would not be wrong to use the reason for the test( syncope).Here they are trying to determine the reason for the syncope and they did. It is orthostatic hypotension? They would not do a tilt table for orthostatic hypotension because they already know the reason for the syncope is orthostatic hypotension.That is why it is not on the LCD. Read the below and see if you understand.

Summary
Syncope may be neurological or psychological in origin or may be caused by orthostatic hypotension, organic heart disease, cardiac arrhythmias or medications. Vasovagal syncope is the most common type of syncope. Tilt table testing is an appropriate diagnostic tool for selected patients when the diagnosis of vasovagal syncope cannot be made based on clinical history and physical examination and appropriate testing (e.g., electrocardiogram, echocardiogram, exercise testing).
 
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