Jacoder
Guest
- Messages
- 158
- Best answers
- 0
Our facility has been doing outpatient physical therapy for about 6 months so we still haven't worked all the kinks out. One problem that is frustraiting me is that of Medical Necessity. Medicare doesn't cover diagnoses like Traumatic Rotator Cuff Tear, Lumbar Spondylosis, and Osteoarthritis, but they will cover symptoms like Low back pain, decreased range of motion, and joint pain. The coding guidelines state that we cannot code signs and symptoms when a definite diagnosis has been established, which is making it very hard to code to medical necessity. Here is an example:
Patient is ordered to have PT for Lumbar Spondylosis. In the initial evaluation the physical therapist states, "patient complains of low back pain . . ." and the doctor signs the bottom of the I.E. Now the I.E. includes a definite dx (that is not medically necessary) yet it also includes a symptom which is medically necessary. However, I feel like this is against coding guidelines. Please tell me if I'm missing something. Thanks.
Patient is ordered to have PT for Lumbar Spondylosis. In the initial evaluation the physical therapist states, "patient complains of low back pain . . ." and the doctor signs the bottom of the I.E. Now the I.E. includes a definite dx (that is not medically necessary) yet it also includes a symptom which is medically necessary. However, I feel like this is against coding guidelines. Please tell me if I'm missing something. Thanks.