Wiki Lab diagnosis and billing

[cynthiaarellano14@yahoo.com]

I was wondering if it was ok to order a lab with a dx that does not support the lab charge and once it gets to the acual biller if it ok to change the code to one that would get the claim paid-I do know that in the event that an audit was done that the lab order would have a different code from what was actually billed and our providers always say to keep them squeky clean and legal. THANKS in advance for any insight that you may give and where the info can be printed would be wonderful. Cindy

 

[thomas7331]

The diagnosis on the claim must be supported by documentation on the provider's order or in the patient's chart that indicates the reason for test. It would be OK to change the diagnosis prior to billing only as long as the corrected diagnosis is still backed up by the record. In the event that the provider or medical record does not give a diagnosis that is payable, labs I've worked with would normally contact the ordering provider for additional information to support the test and keep documentation of that communication on file.

 

[cynthiaarellano14@yahoo.com]

OK, Thanks !!