Wiki Does the referral dx affect billing appointment?

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elsimpso

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I have a coder telling an audiology provider that because the diagnosis on the referral is wrong therefore they cannot bill for the appointment. The referral had the dx code for "risk of hearing loss" and I guess they had Z00.00 listed as one of the dx codes on the referral. Patient was seen and was diagnosed with failed hearing screening. Does the dx listed on the referral make the appointment unbillable? I thought the dx on referrals were informational for the specialist...
 
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elsimpso said:
I have a coder telling an audiology provider that because the diagnosis on the referral is wrong therefore they cannot bill for the appointment. The referral had the dx code for "risk of hearing loss" and I guess they had Z00.00 listed as one of the dx codes on the referral. Patient was seen and was diagnosed with failed hearing screening. Does the dx listed on the referral make the appointment unbillable? I thought the dx on referrals were informational for the specialist...
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It does not make the service unbillable; I don't understand sure why the coder would be saying such a thing. It may be that the diagnosis is incorrect or doesn't support medical necessity, but that doesn't make it unbillable. A diagnosis of Z00.00 most certainly is not right for a hearing test, but the correct remedy for this would be to contact the referring provider and obtain more information or a corrected code - not to tell the audiologist' they can't bill for their service.

I'm not sure if an audiologist is allowed to make a diagnosis since they aren't a physician, but a physician working with the audiologist can certainly assign an appropriate diagnosis based on the results of the testing, so in that case I'd agree that they don't necessarily need to use the referring provider's information.
 
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