Cardiology Coding Alert

Connect this symptom code to your procedure to earn payment

When tests come back without a definitive diagnosis, don't relax your usual high standards for searching out the proper diagnosis code. Our experts reveal the steps you should take when coding normal, negative, or inconclusive diagnostic test results.
 
Problem: For an inconclusive diagnostic test, you shouldn't report a diagnosis that the laboratory gives you after a pathology test, says consultant Maxine Lewis with Medical Coding Reimbursement Management in Cincinnati.
 
But many practices are tempted to report the lab's diagnosis because you may be more likely to get paid if you use it.
 
You also shouldn't report the presumed diagnosis that is the reason for the test, such as a "rule-out" diagnosis, says experienced coder Carrie Caldewey, CPC, coding supervisor for Northern California Medical Associates in Santa Rosa, Calif.
 
Correct coding solution: Code the signs and/or symptoms that the patient has, says Linda Parks, an independent coding consultant in Marietta, Ga. If you code them completely and carefully, you should get paid.
 
Example: A patient presents with complaints of chest pain and presumptive angina. The cardiologist performs a cardiac workup, which turns out negative. Further determination reveals that the patient has only gastroesophageal reflux -- a diagnosis that alone doesn't medically justify the cardiac tests.
 
You should report 786.50 (Chest pain, unspecified) for the cardiac workup, not 530.81 (Gastroesophageal reflux).

Pull Out Primary Reason for Test

When a patient has multiple symptoms, some may be covered for certain tests, while others are not, Parks says.
 
Resource: For Medicare, you can check your carrier's local coverage determination (LCD) to find out which symptoms and diagnoses are covered for each diagnostic test, Lewis says.
 
Remember: Medicare and many other payers allow you to report more than one ICD-9 code, so if the patient has more than one sign and/or symptom that led to the order for the imaging test, you may report all appropriate diagnosis codes.

Prevent Payers From Dipping Into Your Pockets

Consider asking the patient to sign an advance beneficiary notification (ABN) for the test, Parks says. But only use an ABN when you have a reasonable expectation that your carrier will deny payment.
 
Explain to the patient that Medicare may not pay for the test and that the patient may be financially liable if Medicare denies the claim.
 
If your payer does deny claims for interpreting results, you should appeal and try to figure out your insurer's guidelines for tests, Lewis says.
 
With non-Medicare carriers, you may need to use "trial and error" to figure out which symptoms are acceptable to cover a test because the payers play their cards close to their chests.
 
Remember: "You can't make up a symptom," Parks says. Only report codes your documentation supports.