decisionhealth Newsletters, Coder Pink Sheets - 2019 Issue 10 (October)
Getting paid: Spruce up your diagnostic testing documentation, billing watchdog urges
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Article Overview
This article explains Medicare billing and documentation issues tied to diagnostic testing services, including the kinds of recordkeeping problems that can lead to denials. It is aimed at coders, billers, clinicians, and practice managers who order or report diagnostic tests and need to understand how Medicare contractor guidance, CERT findings, and policy variation affect claim support. The discussion covers diagnosis specificity, test-order documentation, signed versus unsigned orders, and the importance of local policy review.
Why This Topic Matters
Diagnostic testing claims can be denied when documentation does not adequately support the service billed. Understanding the article helps practices reduce avoidable denials and improve compliance with Medicare documentation expectations.
Article Sections
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Diagnostic testing documentation and Medicare denials
Introduces the documentation problem described in the article and connects it to Medicare claim denials and error findings for diagnostic services.
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Focus on the basics
Presents general documentation topics for diagnostic testing, including the importance of diagnosis support, test specificity, and clear ordering records.
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Pinpoint your ICD-10-CM coding
Discusses the role of diagnosis coding in supporting diagnostic testing services and the need for specificity when reporting conditions under ICD-10-CM.
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Provide a full, detailed description of the test
Addresses how test orders and related notes should be documented for clarity and completeness in the medical record.
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Check on local policies for signature requirements
Reviews Medicare contractor and manual guidance on signatures, intent documentation, and the need to confirm local policy requirements.
What You Will Learn
- How Medicare documentation problems can affect diagnostic testing claims
- Why diagnosis specificity matters for supporting diagnostic services
- What kinds of ordering documentation are discussed for diagnostic tests
- How signature expectations can vary by policy source
- Why local Medicare guidance should be reviewed before billing diagnostic services
Who Should Read This
- Medical coders
- Billers and reimbursement staff
- Physicians and non-physician practitioners
- Practice managers
- Compliance staff
Codes Discussed
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