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Correct coding

  1. #11
    Default correct coding
    Medical Coding Books
    Codes for symptoms, signs, and ill-defined conditions
    Codes for symptoms, signs, and ill-defined conditions from Chapter 16 are not to be used as principal diagnosis when a related definitive diagnosis has been established.

    This is a statement from the coding guidelines. If you have a definitive diagnosis (and with outpatients, we can use radiology, pathology you should be able to pull from those). You should never treat any insurance different. That is considered Fraud!!! All must be treated equal. Why would they single out medicare for definitive diagnosis and not the insurance companies? To get better reimbursment? Sounds fishy to me. I think your administrative staff needs to talk to someone or research about fraudulent billing practices. Sorry what a hassle for you. Good luck!

  2. #12
    Quote Originally Posted by RBridge View Post
    I code the professional component of radiology and am being told to look at the hospital medical record to find a payable dx even though we code from the final report. I agree that regardless of the insurance, every report needs to be coded the same way. The ICD-9 coding conventions are very explicit about what to use as the dx, as well as the Medicare Billing Manual. Several places in the Medicare manual say that you cannot code from the hospital dx. I have always been taught that you code from the final report. It is not up to the coder to determine medical necessity. Any thoughts would be appreciated.

    I totally agree with Bridge. However, I am unable to find the medicare manual regarding hospital dx. Can any one please help me in searching the location (reference) of medicare manual stating hospital dx can not be coded.

    Thanks for your help in advance!

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