|
Answer: CMS has ruled that you should report a post-test diagnosis confirming the existence of a suspected condition. CMS transmittal AB-01-144 (Sept. 26, 2001) clearly specifies, "If the physician has confirmed a diagnosis based on the results of the diagnostic test, the physician interpreting the test should code that diagnosis." In addition, "The signs and/or symptoms that prompted ordering the test may be reported as additional diagnoses if they are not fully explained or related to the confirmed diagnosis" [emphasis added]. If the test does not confirm a diagnosis, you may report only the signs and symptoms prompting the test.
For example, the physician orders a series of diagnostic tests (e.g., electromyography and nerve conduction studies) for a patient with suspected carpal tunnel syndrome (354.0). Presumably, the physician has documented signs and symptoms (e.g., 726.4, Enthesopathy of wrist and carpus; 782.0, Disturbance of skin sensation; etc.) that prompted the diagnostic testing. If the testing confirms the diagnosis, you may link a diagnosis of 354.0 to the appropriate procedure codes. If the tests do not confirm the diagnosis, report only 726.4, 782.0, etc., and/or other signs and symptoms that prompted the test.
Medicare still does not reimburse diagnostic screenings, even if the screening confirms the existence of a condition that requires additional treatment. For screenings absent signs and symptoms, report the appropriate screening code (e.g., V80.0, Special screening for neurological conditions). You may report any conditions discovered during the screening, but these still will not provide medical justification for the test.
|
