I am having issues where the providers are ordering labs and they are not being covered stating they are not medically necessary due to the diagnosis they are applying to the lab. If I look in the patient's encounter for that date, they usually only have the one diagnosis code. If I look in the charted "problems list", I can find a payable diagnosis. Am I able to consult with the provider to see if they authorize a diagnosis to be used from the problems list on the claim even though they did not chart that in that specific DOS?
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Wiki Coding from the problems list
- Thread starter mwatson22
- Start date
mitchellde
True Blue
You cannot code from the problem list. The documentation for the encounter must support the codes assigned.
thomas7331
Guest
I agree - documentation guidelines say that 'if not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred.' The provider's plan of care should be clear enough to be able to understand why the provider is ordering the tests.