Wiki ICD 10 for pre-procedural Cat Scan

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jstern1

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Hello,

If someone does not have ESRD, is it appropriate/compliant for a physician's office to use N18.6 as the dx on the script for a Cat Scan with contrast? I would imagine Z01.812 would suffice.
The invalid dx could end up on the patient's EMR. I am being advised by the office that this is generic and used for all patients prior to CT Scans.

Thank you.
 
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The ICD-10 code you're submitting needs to be supported by documentation in the ordering provider's records that states that the patient has the condition. If your facility was audited, the payer would be looking at the ordering provider's notes and if that diagnosis was not in those records, then it would be disallowed. If the provider is giving you a diagnosis code that isn't supported in their records, then this is not at all compliant and your facility could be end up having your payments recouped if it was found that the service was not eligible for coverage.
 
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jstern1 said:
Hello,

If someone does not have ESRD, is it appropriate/compliant for a physician's office to use N18.6 as the dx on the script for a Cat Scan with contrast? I would imagine Z01.812 would suffice.
The invalid dx could end up on the patient's EMR. I am being advised by the office that this is generic and used for all patients prior to CT Scans.

Thank you.
Click to expand...

Just to make sure I'm understanding, because this is boggling my mind...

You're being told that N18.6 is a generic diagnosis and is used for all patients prior to CT scans?
 
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If the CT is for a screening the you'd use the Z code rather than dx N18.6 and if it it is an abnormal findings you'd use the abnormal finding dx code. never use a definitive dx code unless the condition has been confirmed.
 
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I would caution you on using Z01.812 as it is specifically for preprocedural labs, Encoder Pro defines it as "Encounter for preprocedural laboratory examination". If you are screening for cardiovascular issues preoperatively you could look at Z01.810-Encounter for preprocedural cardiovascular examination, or if you are screening for respiratory issues, you could look at Z01.811-Encounter for preprocedural respiratory examination.

If either of those don't work for what your CT is being performed for you can always go with Z01.818-Encounter for other preprocedural examination.
 
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jstern1 said:
Yes, all CTs with contrast. Thank you.
Click to expand...

N18.6 is most definitely not a generic diagnosis code. Whoever told you that is definitely mistaken/misinformed/confused about something!

That advice is doubly perplexing considering you're talking about CT scans with contrast. Providers often avoid ordering contrast dye for ESRD patients.

Everyone else has given good suggestions about what Z codes to use.
 
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