Clearer advice given for billing for diagnostic test

Why This Topic Matters

The guidance affects how Medicare claims are coded and documented for diagnostic test interpretation, so it is relevant to compliance and claim accuracy across specialties that read or bill for tests.

Article Sections

1. Policy update for diagnostic test interpretation

   Introduces the CMS memorandum and the broader national scope of the guidance. It frames the article around billing and diagnosis reporting for interpreted diagnostic tests.

2. Screening tests

   Covers CMS guidance for tests ordered without signs or symptoms and the general treatment of screening-related reporting. It also notes that test findings may be recorded separately in appropriate situations.

3. Coding to the greatest degree of specificity

   Summarizes CMS direction on using the most accurate and specific diagnosis code available within ICD-9-CM. The section includes an example illustrating the general specificity concept.

4. Incidental findings

   Describes how CMS addresses findings that are not the reason for the test. It explains the general handling of incidental results in the context of the interpreting physician’s report.

5. Orders for tests

   Explains CMS documentation expectations for test orders communicated through different channels. It also addresses what information may be used when the reason for testing is not immediately available.