tci Medicare Compliance & Reimbursement - 2019 Issue Q4

Reader Question: Avoid Deviating From the Dictation Report Diagnoses

Question: I’ve got a report without a diagnosis that meets the CPT® code’s Local Coverage Determination (LCD) requirement, but the diagnosis on the order does meet the LCD requirement. Can I submit the claim using the ordering diagnosis? Ohio Subscriber Answer: There are a few points to unpack here. First, you should not submit a claim with a diagnosis the provider does not document in the dictation report. If the order includes a different diagnosis than what’s included in the report’s indication, then you should send the report back for an addendum before reporting the...

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