The providers here allow coders to change the CPT codes and Diagnois code. In the provider's note he states why he ordered certain labs (COPD, DM...whatever), but the coder will change the dx for the lab to another one that would pay better. My question is: even though the provider plainly states that he wants for exp., a CBC run for V58.69, is it ok for the coder to change the reason to RA dx that was still documented in another part of the note?
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Wiki Labs - CPT codes and Diagnois code
- Thread starter ESWINT
- Start date
Pam Warren
True Blue
Absolutely not. You should never code for reimbursement, nor should you tweak the billing to get claims paid. Labs ordered should be the labs performed and billed for, along with the diagnosis given for that specific order by the provider. If, after a medical necessity check you determine that a more appropriate diagnosis should be appended, you should query the provider and ask for an addendum or notation in the record that supports the code change. If you change the code so that the lab order is not supported by the providers' original intent---even if it is an error--- you've submitted a non-compliant claim. This is a great educational opportunity for your providers to order labs and correctly link those orders to the appropriate diagnosis.