tci Part B Insider - 2007 Issue 17

PART B MYTH BUSTER: No Diagnosis? No Problem. Code Signs And Symptoms--And Get Paid

Don't make up your own extra digit for incomplete ICD-9 codesMyth: You should expect denials if you report signs and symptoms as primary diagnoses.Reality: In the absence of a confirmed diagnosis, you should report signs and symptoms--and you should expect to get paid.When your physician confirms a diagnosis, you have to use that ICD-9 code, according to program memorandum AB-01-144 from 2002. But when your physician doesn't specify a diagnosis, you should report the patient's signs and symptoms, coding experts say.ICD-9 coding rules state that you can't use a -rule-out- diagnosis on claims, says Kim Garner...

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