Case Study:
Don't Overlook Reporting Test Reason, Nonincluded Symptoms
Published on Mon Jan 04, 2010
Your strep test denials may be a victim of top-only coding. If strange rejections plague your practice, you might need to expand your ICD-9 reporting beyond the primary diagnosis field. See how a Maryland pediatric group's streamlined diagnosis coding triggered endless rejections of 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A). Here's how to stop the same from happening on all types of claims. Support Test's Medical Necessity With Related Dxs Scenario: When an established patient comes in with a sore throat and the pediatrician orders a rapid strep test and diagnoses strep, a payer refuses to pay for the test, related an attendee at The Coding Institute's December 2010 Pediatric Coding and Reimbursement Conference in Orlando. "Should I use a different strep code?" the coder wondered. She was coding the office visit and rapid strep encounter with: • 992xx (Office or Other Outpatient [...]
