Vascular coder in Michigan who has questions with the LCD edits for this region


Fort Collins, CO
Best answers
Hello I am a Vascular coder in Michigan and I want someone in the same CMS region that I may have a running conversation as it relates to some troubles I have with the ICD-10-CM codes for the non invasive vascular diagnostic studies (i.e. 93880-93895, 93922-93931, 93965-93971, and 93990). I am experiencing problems it seems is that the my coding area is not getting the needed medical documentation to indicate the greater specificity that is needed with ICD-10. If it helps for background my company is in charge of billing out the professional charges only of the studies they do in the Vascular Lab, but the medical staff that works in the office with the physicians are not employed with my company, so unfortunately my company is a the "mercy" so to speak of the quality of information that they( the staff) choose to provide us on the order from the referring provider. The interpreting physician does provide a statement on the finalized report that states the "Reason for the Exam" or the "Indication" and it often be "absent pulses" or "pain at rest" even worse yet an unspecified code. To toss in an extra issue some of our patients are outpatients and some are admitted in the attached hospital. Now I know for the outpatients as per the ICD-10 CM guidelines in section IV: portion K that "[f]or outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding" (which it is in my situation)that we can "code any confirmed or definitive diagnosis(es) documented in the interpretation". Would I be following correct coding guidelines by doing so?

My other big question is these same type of non-specific, detailed orders also come to us from the inpatients as well, now our clinic is set up to see the medical documentation from the patient's EHR as we are on the same system, but am I following correct coding guidelines if I utilize another medical provider, who is on the same care team, that my providers are now a part of because they have accepted the medical order to preform the diagnostic test on the patient? Would the rules of the Uniform Hospital Discharge Data Set (UHDDS) apply in these cases? Once again I do have the finalized report at the time of coding.

In addition I know that based on the ICD-10-CM and the UHDDS that there are certain guidelines as to when and when not it is correct coding usage to utilize an uncertain diagnosis code. Any thoughts?

While I appreciate those of you from other regions offering your thoughts I REALLY need someone in the same area I am in as, I am sure you are aware that a Local Coverage Determination and its rules supersedes the National Coverage Determination for CMS.

Thanks SO MUCH!!!!!