Wiki ICD 9 codes for HCPCS

[Jstapleton57]

I have been told that when billing for a HCPCS code, if there is no ICD9 code listed from the medical facility ,that we can assign a ICD9 code from the list for acceptable medicare codes for that item. Usualy what comes to us is a prescription and and admit slip that may have a very general description of why the pt had been seen (ex. knee pain or knee injury).

In my opinion, in these situation, the Dr. needs to be queried for the treating diagnosis. I have tried to find some information on Noridian's web site, but have had no success. I would appreciate any information regarding this topic.

 

[mitchellde]

You can never assign a diagnosis code based on anything other than the providrs documentation in the patient's medical record. The diagnosis is the patient's and it cannot come from the Medicare list of acceptable dx codes. If you do not have enough information then the provider needs to be queried. you need the actual progress note to code a claim not an admit slip or prescription.