Optimize Reimbursement for Diagnostic Testing Of Strokes With Proper Documentation
Published on Sun Oct 01, 2000
Neurologists often have problems getting reimbursed from Medicare and other third-party payers for performing various tests on patients who may have had a stroke. Problems can develop because the neurologist did not chose the appropriate ICD-9 or CPT codes. If he or she does not provide documentation for the medical necessity of the tests, problems may arise because carriers do not understand the need for more than one test, or they may not be covered by the insurance carrier. Avoid denials by properly coding and documenting the reasons for the tests in the patients file.
Coding Signs and Symptoms
If the diagnosis is not known before the test is performed, the claim should be coded based on the signs and symptoms noted by the neurologist when the test is ordered. According to Karen Duane, CPC, coding specialist for the Phoenix-based Barrow Neurological Institute, one of the largest full-service neuroscience centers in the southwestern United States with 20 neurologists, if the test is being performed to see if the patient has had a stroke, then the common signs and symptoms include: paralysis (344.9), hemiplegias (342.91), occlusion of certain arteries (434.9x or 433.1x), stenosis (447.1), aneurysyms (442.9), speech problems (784.5), injuries to blood vessels (904.9), cerebral artheriosclerosis (437.0), transient cerebral ischemia (435.9), and vision loss (369.9). Duane also suggests that the coder check with his or her local Medicare carrier and third-party payers to obtain a list of which diagnosis codes are approved for the tests that the neurologist wants to perform.
Note: Make sure the ICD-9 code accurately represents the diagnosis. Never choose an ICD-9 code just because you know it will get the procedure code reimbursed.
Diagnostic Tests for Stroke
Steven W. Dibert, MD, a neurologist at the Neuroscience and Spine Center in Gastonia, N.C., and member of the board of directors of the American Society of Neuroimaging as well as the board of the American Academy of Neurology/Neuroimaging Section, offers the following example of diagnostic tests for strokes: A patient may have stenosis of an artery in their head, and the neurologist orders a magnetic resonance angiography (MRA) 70541, magnetic resonance angiography, head and/or neck, with or without contrast material[s]) or a magnetic resonance imaging (MRI) to look at the blood vessels in the head (70551, magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material) or 70553, magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material, followed by contrast material[s] and further sequences) to see where the stroke took place and whether it was embolic (a piece of material that came up an artery and caused the stroke) or thrombotic (the artery closed off within the brain itself).
Other tests that [...]
