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Thread: Outpatient Diagnostic Testing/ Physician Office

  1. #1

    Default Outpatient Diagnostic Testing/ Physician Office

    AAPC: Back to School
    I am hoping someone can help me on this, through school and all of my experience as an outpatient physician office coder (5yrs), I have been under the impression that we cannot code a diagnosis that was found after testing or procedure. For example, patient has renal disease so doctor orders an echo in office and finds Mitral Regurgitation. I understood the proper coding would be to code the renal disease because we didn't find the MR until after the testing. Well, I was reviewing some of my school books and it states for a physician an outpatient diagnostic test result if found abnormal may be coded with that abnormality, such as the Mitral Reg. Now I am unsure, is this just for testing that we can use a "found" DX? When I have a patient go in for a heart cath and we find CAD and then place a stent, I know we have to code the cath with a DX that was the reason for going to Cath lab, but with the stent because it was done after we found CAD, we could then code the stent with CAD. Hope this makes sense, bottom line, I thought if it was inpatient we can use DX found before, after, rule out, and so on, but with outpatient it had to be an existing code. Any help is appreciated!!! Gail

  2. #2
    Join Date
    Apr 2007
    Chattanooga, TN


    I have been coding for over 13 years and I have never been told or read anywhere that a procedure/diagnostic test could not be billed with findings as primary dx. You can code the dx discovered during the procedure be it in or outpatient. If our patient has chest pain and goes in for a Cath & the MD places a stent for CAD or MR we will bill the stent with the CAD or MR codes not the chest pain code. Hope this helps.

  3. #3


    I think the key here might be timing. If you receive the results of the diagnostic testing BEFORE billing the insurance company, the PHYSICIAN must document or at least authorize (sign off that) the documentation and patient notification of the findings in the chart, then of course you can submit the final dx code with the OV code. If however, you have sent the bill to the insurance company before receiving results, an addendum noting the dx still needs to be placed in the chart and the corrected bill with dx code re-sent to the insurance company.
    When I was in school, emphasis was made that if at all possible, wait to bill the insurance company until after test results were received so the highest specificity of diagnosis code be included.

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