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American College of Radiology Guidelines and Standards - Documentation Guidelines and more for General Diagnostic Radiology
Diagnostic Radiology - Manual From Trailblazerhealth
Mammogram Billing & Coding Guidelines- from CMS
Nomenclature and Classification of Lumbar Disc Pathology - Terminology, definitions and ICD-9 Codes of Lumbar disc diseases (AskLeslie.net highly recommends)
Internet Only Manuals for Radiology from CMS regarding CPT and ICD-9 coding, physicians' orders and billing
10.6.1 - Place of Service Instructions for the Interpretation of Diagnostic Tests 10.6.2 - Place of Service Instructions for the Technical Component (TC) and Professional Component (PC or Interpretation) of Diagnostic Tests Not Personally Performed Or Supervised By A Physician 10.6.3 - Date of Service (DOS) Instructions for the Interpretation and Technical Component of Diagnostic Tests
Physician Signatures for Diagnostic Tests - from Highmark Medicare Services - July 31, 2009
Radiation Therapy - Manual From Trailblazerhealth
Selecting the Primary Diagnosis Code for Diagnostic Services - in the Official Guidelines for Coding and Reporting, Effective Oct 1, 2007, see section page 90, Section L:
If doing the TC portion only, and/or there is no report or finding:
"For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses."
If the Global is being billed and/or the Professional Component (-26 modifier) is being billed:
"For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses. "
You can also view similar information with more detail at CMS, IOM 100-04, Chapter 23
"For outpatient claims, providers report the full ICD-9-CM code for the diagnosis shown to be chiefly responsible for the outpatient services in the appropriate FL. For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom is reported (786.2). If, during the course of the outpatient evaluation and treatment, a definitive diagnosis is made (e.g., acute bronchitis), the definitive diagnosis is reported (466.."
Transmittal 80 from CMS regarding Physicians Orders & chart documentation for outpatient facilities
American Medical News - Gov't
OIG Criminal & Civil Enforcement
- Cenla Community Action Committee's Financial Management Practices and Systems Did Not Always Meet Federal Requirements
- Rhode Island Hospice General Inpatient Claims and Payments Did Not Always Meet Federal and State Requirements
- Massachusetts Medicaid Payments to Calvin Coolidge Nursing and Rehabilitation Center for Northampton Did Not Always Comply With Federal and State Requirements
- Wyoming Incorrectly Claimed Enhanced Reimbursement for Medicaid Family Planning Sterilization Costs
- The Medicare Contractor's Payments to Maryland Providers in Jurisdiction 12 for Full Vials of Herceptin Were Sometimes Incorrect