Cardiology Coding Alert

Question: My doctor often uses a diagnosis of evaluation of left ventricle (LV) function or evaluation of ejection fraction (EF), particularly with echoes. What ICD-9 should I use?

Texas Subscriber

Answer: More than likely, your cardiologist suspects something; otherwise he would not order the echo. In an outpatient setting, you can use the signs and symptoms that prompted the test.

Watch for: In your provider's documentation, look for these phrases: "probable," "suspected," "likely," "questionable," "possible," and "still to be determined." These indicate that the provider has not formally diagnosed the patient with the condition or disease.

Until testing or diagnostic services confirm that diagnosis, you should rely on signs and symptoms instead to justify medical necessity for any services the physician provides.

Here's why: If you reported a suspected condition or disease, you would label the patient with an unconfirmed diagnosis, possibly affecting his future medical treatment. Reporting signs and symptoms when testing cannot establish a definitive diagnosis still allows physician reimbursement.