Diagnostic Tests

Why This Topic Matters

Diagnostic test claims can be denied or paid differently depending on how the reason for testing and the final documented diagnosis are reported. This article helps readers understand the scope of Medicare’s policy update and the types of documentation issues that affect claim processing.

Article Sections

1. Medicare policy update for diagnostic test coding

   Overview of the CMS policy change and the general coding approach for diagnostic tests under Medicare.

2. Orders and documentation of diagnostic tests

   Discussion of acceptable ways diagnostic test orders may be communicated and documented in the medical record.

3. Unconfirmed diagnoses and symptom-based reporting

   Guidance on handling uncertain referring diagnoses and situations where the test does not establish a definitive diagnosis.

4. Final diagnosis, medical necessity, and screening tests

   Coverage of situations where the final diagnosis may affect medical necessity, along with guidance for screening-based testing and incidental findings.