decisionhealth Newsletters, decisionhealth - 2009 Issue 2 (February)
Diagnostic Testing / ICD-9-CM coding for diagnostic tests
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Article Overview
This article explains how diagnostic test results should be reflected in ICD-9-CM diagnosis reporting across common testing scenarios, including confirmed findings, nondiagnostic or normal results, uncertain referring diagnoses, incidental findings, unrelated coexisting conditions, and screening examinations. It is aimed at coding specialists, contractors, physicians, hospitals, and other health care providers who need to understand the general reporting framework and the role of official ICD-9-CM outpatient guidelines and related federal references.
Why This Topic Matters
Accurate diagnosis reporting for diagnostic tests affects claim consistency, record integrity, and compliance with official coding guidance. The article is relevant to organizations and professionals that order, perform, interpret, or bill for diagnostic tests under ICD-9-CM rules.
Article Sections
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Overview and regulatory background
Introduces the federal and coding-policy context for diagnostic test diagnosis reporting under ICD-9-CM. Identifies the general audience and purpose of the guidance.
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Determining the primary diagnosis for diagnostic tests ordered due to signs and/or symptoms
Covers how diagnosis reporting is handled when tests are ordered because of a symptom or sign and a result is confirmed, normal, or non-diagnostic. Includes broad examples involving imaging and pathology.
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Instruction to determine the reason for the test
Addresses obtaining the reason for testing when the ordering information is incomplete or unclear. Discusses documentation sources and communication between involved providers and facilities.
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Incidental findings
Describes the treatment of findings discovered during testing that were not the original reason for the study. Explains the general distinction between primary and additional diagnosis reporting in this context.
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Unrelated/co-existing conditions/diagnoses
Summarizes how unrelated or co-existing conditions identified during testing may be reflected in diagnosis reporting. Uses general clinical scenarios to illustrate the topic.
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Diagnostic tests ordered in the absence of signs and/or symptoms
Explains the general approach for tests ordered without symptoms or other evidence of illness or injury, including screening contexts and related policy considerations.
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Use of ICD-9-CM to the greatest degree of accuracy and completeness
Reviews the principle of selecting the most specific applicable ICD-9-CM diagnosis and the importance of complete coding. Also discusses digit-level specificity and related coding references.
What You Will Learn
- How diagnostic test outcomes are reflected in ICD-9-CM diagnosis reporting
- How symptom-based testing differs from screening-based testing
- How incidental and unrelated findings are treated in reporting
- How incomplete or unclear test-order information is handled
- How specificity and completeness principles apply to ICD-9-CM diagnosis selection
Who Should Read This
- Coding specialists
- Contractors
- Physicians
- Hospitals
- Other health care providers
- Testing facilities
- Physician office billing staff
Codes Discussed
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