Wiki Are we allowed to give dx codes for payment on EKGs?

[ngeorge05]

Does anyone have any information in regards to us as coders being allowed to give providers the actual diagnosis that are payable for EKGs. I always believed that I couldn't lead a physician on about which codes are for payment but I have couple of doctors who do EKGs that may be denied because of the diagnosis codes they submit. I have sent the doctors the guidelines but now they are asking for the specific code. Would this be unethical?

From medicare I use this link to determine if it is payable.
http://medicare.fsco.com/Fee_lookup/LCDDisplay.asp?id=L29163

 

[mitchellde]

The dx code submitted must be equal to the diagnosis documented in the documentation, If you do give them specific codes and they use those codes for submission, then as a coder you review the documentation prior to claim submission then you must change the dx code to match the documentation. If you do not review the documentation prior to claim submission then how do you know if the codes submitted are correct? If you supply the payable codes then you must suspect that there will be cases submitted by the provider where the code will not match the documentation, then how could you as a coder submit the claim without a review of the documentation? The diagnosis is the patient's not the providers, so the code submitted must be the patient's diagnosis and it will not always be "the one that gets it paid"!