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Thread: documentation of medical necessity for labs

  1. #1
    Join Date
    Apr 2007

    Default documentation of medical necessity for labs

    AAPC: Back to School
    If a patient has listed in assessment: 278.00, 401.9, 250.00, 272.4 and 268.9 and on the bottom of the note in the labs ordered section, the doctor circled are CMP, CBC, A1C, Lipid Profile, Urine microalb/creatinine.

    Would an auditor match each dx from the assessment to the lab test that was circled at the bottom, or does the doctor have to match them up in his documentation of the visit?

    What is considered "easily discernible" in Medical Documentation? Is a list of dx on assessment, then a list of labs circled on the progress note acceptable or does the doctor have to specifically tie each test he orders to the specific matching dx?
    Heather Winters, CPC, CFPC

  2. #2
    Join Date
    Apr 2007
    Swainsboro/Statesboro, GA

    Default Medical necessity

    So many labs have LCDs or NCDs making specific diagnoses to support medical neccessity a must. However, it does matter who you are billing for and on what type form. For instances, if you are the physician's office billing for the lab test, you have to link the diagnosis to the lab procedure. This is also true for an outpatient lab. If the physician does not link the diagnosis to each procedure, it would be reasonable for the lab to assign all of the codes listed to the procedure, however most billing systems would have a claims scrubber that would flag all diagnosis codes that would not support that procedure when billed with those codes.
    Freda Brinson, CPC, CPC-H, CEMC
    2014 President AAPC Swainsboro, GA Chapter
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

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