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Pathology/Lab Coding Alert

READER QUESTIONS:

Guard Against 'Bad' ICD-9 With ABN

Published on Fri May 22, 2009

Question: When we receive an order for a lab test, do we need an ICD-9 code from the ordering physician, or can we assign the ICD-9 code ourselves based on the medical record? Tennessee Subscriber Answer: The ordering physician should provide either ICD-9 code(s) or a narrative diagnosis to demonstrate medical necessity for a test. If the physician submits an ICD-9 code, you cannot alter the code without getting documentation from the physician to allow the change. You can, however, assign an ICD-9 code based on a narrative diagnosis, even if the narrative does not exactly match the code descriptor. If you think that you dont have adequate documentation of a payable diagnosis for a test, you should get the patient to sign an advance beneficiary notice (ABN).That way, you can bill the patient if Medicare fails to pay. Caveat: CMS encourages, but doesnt require, the physician to provide medical [...]
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