Avoid Medicare claim errors and denials.
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Tag Archives: test
Test Your Understanding of Modifier 57
Understanding modifier 57.
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Biotech Executive Charged in COVID-19 Test Fraud Case
As if the coronavirus pandemic wasn’t bad enough as it is, fraudsters in the healthcare industry are manipulating it to further their wealth. The ongoing public health crisis has spawned a rash of fraudulent schemes, making COVID-19 fraud investigations a top priority for government agencies determined to root out fraud and corruption being committed against […]
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test
New COVID-19 Test Codes Effective Immediately
Just when you thought you had all the COVID-19 coding for laboratory testing figured out — hold the phone — there are three new CPT® codes. These newest codes are effective June 25, 2020. CPT® Code Long Descriptor 0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets […]
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Q&A: Coding from ED documentation and test results
Q: Can you code strictly from emergency department (ED) documentation? Can you code from test results and imaging (radiologist reports)?
A: Coders can assign diagnosis codes based on documentation of any licensed independent provider that provides direct care to the patient. This includes physicians, nurse practitioners, and physician assistants who provide care to the patient during this encounter. Thus, the documentation of ED physicians or other providers (nurse practitioners and physician assistants) can be used to assign a code.
This comes with two notes of caution, however. First, this documentation must not conflict with the attending physician. If the documentation conflicts, then query for clarification. Second, if the ED physician documents a diagnosis, but you see no evidence of treatment or monitoring continued through the inpatient stay, query for the significance of the diagnosis.
As for the second piece of your question, diagnosis codes cannot be assigned based on test results or imaging. The documentation of radiologists and pathologists cannot be used to assign diagnosis codes, as such physicians do not provide direct patient care. Coders or clinical documentation improvement (CDI) specialists would need to query the attending provider to assign the appropriate diagnosis code.
Coding Clinic for ICD-10-CM/PCS has published guidance regarding the use of such reports to further specify the location of a fracture or cerebrovascular accident from imaging. But we first must have the diagnosis as documented by the attending physician or provider responsible for the direct care of the patient.
Editor’s note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, and CDI education specialist at HCPro, a division of BLR, in Danvers, Massachusetts, answered this question on the ACDIS website. Contact her at [email protected].
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
Need expert coding advice? Submit your question to editor Steven Andrews at [email protected] and we’ll do our best to get an answer for you.
Allergy Test CPT Codes Limitation for Florida Blue
Reimbursement for allergy testing is based on the number of each type of test performed by the same physician and is subject to the following limitations when the coverage criteria are met
Reimbursement Information:
Reimbursement for allergy testing services includes the following components,
- Supplies (e.g., sterile diluents, syringes, needles)
- Monitoring the physical status of the patient during testing
- Observation, recording, and interpretation of the test results
Reimbursement for “allergy testing” is based on the number of each type of test performed by the same physician and is subject to the following limitations when the above coverage criteria are met,
Limitation:
Reimbursement for “allergy immunotherapy” is based on the number of procedures performed and is subject to the limitations below,
See Also Coding Guidelines for Allergy Codes
New CPT® Code for Reporting COVID-19 Test
On Jan. 30, the World Health Organization (WHO) declared the 2019 novel coronavirus (COVID-19) disease outbreak a public health emergency of international concern. The outbreak has since been elevated to a pandemic and President Trump has declared the coronavirus pandemic a national emergency in the United States. Communities across the country are shutting down to […]
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POLL Test date ot interp date
Which date of service do you use?
In or outpatient POS
EKGS, Echos etc
In or outpatient POS
EKGS, Echos etc
This POLL does NOT track who responds
Positive Feccal Occult test and pre-screening visit
A patient has a positive fecal occult blood test (FOBT) and is referred to GI for a colonoscopy. Can the GI physician bill for a pre-screening visit? In many cases the only symptom may be a positive FOBT. This question has come up several times in the past few weeks and am having trouble finding a definite answer or even a generalized answer
Thanks!!
Dolores