Wiki Changing Diagnosis codes on EMR labs orders?

[aimes]

We have a scenario where we are getting a high number of lab denials due to the incorrect or non covered diagnosis being input on the orders by the physicians.
As a "solution" it was suggested that the coding team could go into the lab orders, and change/correct the diagnosis codes to a payable diagnosis "if" it's documented in the patient's chart.
We see this as a problem, as we were always taught that a physician needs to create a New lab order with the updated diagnosis code on it and that no one other than the Physician can alter the orders.
Im trying to find something in writing preferably from AMA or CMS or some other reputable site that states this. Our coders do not feel comfortable doing this.
Does anyone have any insight?
Thanks!!!

diagnosis codes, diagnosis coding

 

[kdlberg]

You can put it to them like this. Patient A needs test B for clinical reason C. Altering reason C, aka the diagnosis code, is making a medical judgment. If the provider puts "needs this test because of hypertension "and you change it to "because of diabetes," you've technically decided why the patient needs a test--which you can't do, because you're not a clinician.

diagnosis codes, diagnosis coding

 

[keke74]

I agree with KD. Modifying physicians orders/dx raises compliance concerns. I'm sure altering physician diagnoses or any provider documentation for any reason including avoidance of denials is a violation of compliance standards.

diagnosis codes, diagnosis coding

 

[TThivierge]

Aimes
I would not change the dx code ...you need to take lead by the physicians or provider's order. However some labs chosen are due to the inferred name of the lab test ...CPT 84153 prostate lab . Thus N42.9 orN52 linked to this may help. Add dx Z01.89 and Z13.89 can be used as 1st dx code selected labs. Also there are lab editing programs to help too coinciding with NCCI. In addition CPT 89262 glucose is required every so many months with elderly or patients sick with ongoing dx DM E11 or prediabetes R73.
I hope helped you somewhat
Lady T

diagnosis codes, diagnosis coding

 

[csperoni]

One more vote for "do not change the diagnosis assigned." The only exception I might make is if the records state "ordered CBC due to fever" but then when the order was put in, someone assigned a different diagnosis code. If the words are already linked in the chart, but there was a data entry error, I would be OK with a coder correcting that.

diagnosis codes, diagnosis coding

 

[ninksm]

I have an additional question with regards to this, if a physician agrees to "update/add/change" a diagnosis on a lab order do they need to do a complete new order or can they just add the new diagnosis code to the existing lab? What is the legal requirement to make an amendment to the original order?

diagnosis codes, diagnosis coding