gabetteyoung@yahoo.com
Contributor
I code for a hospital. We have an orthopedic clinic that routinely sends patients for MRIs. Quite often, the only diagnosis on the order will either be for a complete rotator cuff tear or a meniscal tear - they don't list signs or symptoms or use any type of "rule-out" verbiage. More often than not, when I look at the MRI report it will state "no meniscal tear detected" or "no rotator cuff tear" or possibly "partial rotator cuff tear." When this happens, I usually contact the clinic and ask them to send a new order with signs/symptoms rather than a definitive diagnosis. The problem is that the clinic is using the rotator cuff tear or meniscal tear diagnoses to get the MRI pre-approved, so if the claim is not coded the same as the pre-approval, the MRI is being denied.
I've been told by people higher up the ladder from me (not necessarily coders) that I should code according to the orders which I don't think is correct when I can look at the MRI report and see that it doesn't match the diagnosis on the order. This is a very small hospital where the billing department and the HIM department are very closely intertwined. I understand we want these procedures covered, but I feel they are looking at this strictly from a financial standpoint and I'm trying to make sure I code my accounts correctly.
It seems to me the orthopedic clinic is using the wrong diagnoses to get these tests approved, and because that's the only thing on the order I have no way of knowing whether this is a follow-up for an existing condition or if they are trying to rule-out a new problem. When I bring it up, I'm told to code according to the order. If that's the way it should be done, I'm not sure why we need coders - data entry people would be sufficient.
Am I looking at this wrong or misunderstanding something?? I am not sure how to handle this and any advice would be greatly appreciated.
I've been told by people higher up the ladder from me (not necessarily coders) that I should code according to the orders which I don't think is correct when I can look at the MRI report and see that it doesn't match the diagnosis on the order. This is a very small hospital where the billing department and the HIM department are very closely intertwined. I understand we want these procedures covered, but I feel they are looking at this strictly from a financial standpoint and I'm trying to make sure I code my accounts correctly.
It seems to me the orthopedic clinic is using the wrong diagnoses to get these tests approved, and because that's the only thing on the order I have no way of knowing whether this is a follow-up for an existing condition or if they are trying to rule-out a new problem. When I bring it up, I'm told to code according to the order. If that's the way it should be done, I'm not sure why we need coders - data entry people would be sufficient.
Am I looking at this wrong or misunderstanding something?? I am not sure how to handle this and any advice would be greatly appreciated.