Wiki Glucose Test-Patient with DM

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hollyphipps27

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Patient with DM came in for sick visit and provider had glucose checked as well. He did not address the DM anywhere in his documentation, but we have to attach a diabetes diagnosis code to the glucose test to bill it out. Does the provider need to add the DM code to his note??? I am under the impression that we can't bill any diagnoses that are not documented by the provider, but he is disagreeing with me stating we can add it on the billing end. Please clarify for me!

Holly R.
 
If it wasn't documented, it can't be coded. That's our rule lol..
I would again ask the physician to document the DM to ensure proper payment and avoid your patient getting an unnecessary bill for the glucose check.
 
He must also specify the diabetes type, if it is not documented as to type they the coder will have to default to the type 2 designation.
 
Let me rephrase/simplify to confirm...

If provider orders glucose test 82947 (which requires diabetes diagnosis for billing), must he put a diabetes diagnosis in his note??? 250.00 was billed because of the test, so that diagnosis needs to be included in his note correct?

Provider is arguing with me stating "if you go by that logic we should code hypertension on every patient because we check their blood pressure". NO!!!
 
By that logic he is correct, if you code diabetes for every glucose test then you would code HTN for every BP check. However we do not do it that way as the condition must be documented. What if the patient had pre diabetes, or borderline diabetes and that was the reason for the glucose check, the ex code in that case would not be 250.00. What if the patient was in fact type 1 diabetes or had late adult onset due to autoimmune disease or had diabetes due to pancreatitis, then the code would not be 250.00. You cannot assume the ex code based on the test or study ordered.
 
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