I wouldn't advise coding based on what will pay if it's not supported by the documentation...you'd be setting yourself up for trouble. The diagnosis code that you assign to each CPT code is what payers use to determine medical necessity (without reviewing the records, anyways), so if it's not an obvious connection (like thyroid testing for anemia), the doctor is just going to delay their reimbursement, if they get any at all. I'd suggest pulling up clinical policies from the insurers you're dealing with on a case by case basis, to show the doctor what indications the insurers consider medically necessary or experimental/unproven for the procedures in question. They usually have extremely detailed rationale to explain their stance.
I suspect that the doctor is probably just not communicating their thoughts well in this case. Just guessing, here, but it sounds like maybe they suspect anemia as the cause of the fatigue, but are running a thyroid test to rule out thyroid problems as the source. If that is the case, they should work on phrasing in their documentation, so they're not misunderstood to sound like they're ordering unnecessary labs. CMS documentation guidelines say "If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred." The physician should make an addendum to the record to make the reason for the thyroid test a little more clear, since they went out of their way to mention the anemia, in the first place. If they had just listed the lab by itself, then I'd be more comfortable with assigning a code based on signs and symptoms. It's hard to say for sure without actually seeing the chart, though...Hope that's helpful!
Brandi Tadlock, CPC, CPMA
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