Diagnostic Testing - Articles

The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing. Acceptable Examples include: Cardiology and Vascular Surgeons Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels) EKG (electrocardiogram) – Stress test, Cardiac ...

On June 17, 2016, CMS announced the release of its final rule implementing section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA). This final rule requires reporting entities to report private payor rates paid to laboratories for lab tests, which will be used to calculate Medicare payment ...

The following information is according to Novitas Solutions L35084. Lower extremity arteries (abdominal aorta, iliac, superficial femoral and infrapopliteal arteries): This includes: Lifestyle-limiting claudication Focal hemodynamically significant lesion Ischemic rest pain Non-healing tissue ulceration Focal gangrene Stent placement in infrapopliteal vessels is not expected to be often indicated and in those cases the rationale for stent placement must be explained in the record. CPT codes: 37221 37223 37226 37227 37230 37231 37234 37235 ICD-10-CM codes: Type 1 diabetes mellitus E10.51 - with diabetic peripheral angiopathy without gangrene E10.59 - with other circulatory ...

Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns. If a physician confirms a diagnosis based on the results of a diagnostic ...

When billing for mammograms, documentation must include the purpose and the result of the procedure. Two major purposes of mammogram are diagnostic and screening. It can also be used mammography to guide other procedures. Tip 1: Confirm the Purpose Determine the purpose of the procedure; i.e....

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Medicare has specific physician supervision requirements for diagnostic tests. Each CPT® code that represents a diagnostic test is given a supervision indicator in the Medicare Fee Schedule. From Chapter 15, of the Medicare Benefit Policy Manual describes these levels of supervision: General...

The Medicare Modernization Act of 2003 added a benefit for Medicare patients for services provided after Jan 1, 2005. Medicare added coverage for screening Medicare patients for diabetes, if the patient has an individual risk for diabetes. There are diagnosis and frequency limitations. The...

Modifier 26 is a CPT® modifier used to indicate that the physician practice performed the professional component only of a diagnostic test. There is no CPT® modifier for the technical component. The facility that performs only the technical component uses a HCPCS modifier, TC. Some...

Many-- but not all-- diagnostic tests are composed of a technical and a professional component. These tests are identified in the Medicare Physician Fee Schedule. When the physician practice performs both components, the service is billed globally, with no modifier. If the technical component is...

What does a physician need to document and in what format? If you are a radiologist, you know the answer to this question. Many diagnostic tests have both a professional and a technical component. Whether or not a test has both is found in the Medicare Physician Fee Schedule Data Base. A...

To bill for placing the purified protein derivative (PPD) skin test,use CPT® code 86580. Use this code when the nurse or medical assistant places the test on the patient's skin. The CPT® definition of the code is: Skin test, tuberculosis, intradermal. The code has a technical component...