decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / B-01-61
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Article Overview
This article explains Medicare guidance for diagnostic test orders, diagnosis reporting, and related ICD-9-CM coding practices for physicians, laboratories, radiology, and pathology settings. It covers how diagnostic information should be documented, how primary and secondary diagnoses are handled in different scenarios, and how coding specificity is addressed in a series of Q&A examples. The memorandum is relevant to providers, coders, billing staff, and compliance teams working with diagnostic testing and claims documentation.
Why This Topic Matters
It helps readers understand the documentation and coding expectations surrounding diagnostic tests so claims can be supported consistently and reviewed appropriately. The article is especially useful for organizations that bill for outpatient laboratory, radiology, and pathology services under Medicare rules.
Article Sections
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Incidental Findings
Discusses how additional findings identified during diagnostic testing are treated in relation to the main reason for the test. Includes illustrative examples from imaging studies.
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Unrelated/Co-Existing Conditions/Diagnoses
Addresses reporting of conditions that are not the reason for the test but are identified during the encounter. Uses an example involving radiology and concurrent diagnoses.
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Diagnostic Tests Ordered in the Absence of Signs and/or Symptoms (e.g. screening tests)
Covers diagnosis reporting when testing is ordered without documented signs, symptoms, or other evidence of illness or injury. Focuses on general reporting expectations for the reason the test was performed.
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Use of ICD-9-CM To The Greatest Degree of Accuracy and Completeness
Reviews the broader ICD-9-CM guidance referenced in the memorandum, including code specificity and completeness. Includes several examples spanning pathology, radiology, laboratory, and outpatient settings.
What You Will Learn
- How the memorandum addresses documentation for diagnostic test orders
- How primary and secondary diagnoses are discussed for interpreted tests
- How incidental and co-existing findings are handled at a high level
- How the article frames ICD-9-CM accuracy and completeness guidance
- How the attachment uses Q&A examples to illustrate reporting concepts
Who Should Read This
- Physicians
- Laboratories
- Radiology departments
- Pathology departments
- Medical coders
- Billing staff
- Compliance teams
- Hospital outpatient coding staff
Codes Discussed
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