PART B CODING COACH: Four Q&As Help You Fall in Line With Heart Disease Screening Criteria

Why This Topic Matters

Correctly identifying screening eligibility, covered tests, and associated diagnosis reporting helps support compliant Medicare billing and reduces the risk of claim denials or missed reimbursement opportunities.

Article Sections

1. Who Is Eligible?

   Explains the general Medicare beneficiary eligibility framework for the screening benefit and highlights documentation and ordering considerations. It also addresses patient education and notices related to potential out-of-pocket costs.

2. Which Tests Are Covered?

   Describes the laboratory testing associated with the screening benefit and discusses whether the tests are ordered separately or as a panel. It also notes related laboratory and billing considerations.

3. Which ICD-9 Codes Do I Report?

   Reviews diagnosis reporting for the screening encounter and discusses commonly associated screening-related diagnosis categories. It also addresses the need to confirm the reason for the service and mentions additional diagnoses that may be relevant to payer review.

4. Can I Report an E/M for the Screening?

   Addresses situations where a separately identifiable evaluation and management service may be reported along with the screening encounter. It also includes a brief example involving a separate complaint and related laboratory screening.