Medicare Compliance & Reimbursement - 2005 Issue 1
Solve the Mystery of Rejected Interp Claims
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Article Overview
This article explains general coding and reimbursement issues related to diagnostic test interpretations in physician and inpatient settings. It is aimed at coders, billers, and physicians who need to understand when a test interpretation may be reported separately, how the interpretation can affect evaluation and management services, and how CPT component reporting is described in the context of professional and technical services.
Why This Topic Matters
Diagnostic test interpretation can affect both claim submission and evaluation and management coding, and misunderstandings may lead to duplicate billing or denials. The article helps readers understand the general documentation and reporting concepts involved in these situations.
Article Sections
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Avoid Double-Billing
Discusses the general issue of multiple physicians being involved in interpreting ordered diagnostic studies in hospital and inpatient settings. It covers why separate reporting may be affected when a report already exists.
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Consider Test Results Toward E/M Level
Explains how review of diagnostic test results may factor into medical decision-making for evaluation and management services. The section uses broad emergency and observation-care context to illustrate the concept.
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When You CAN Bill, Append -26
Reviews CPT component reporting concepts when only the physician interpretation is provided separately. It also addresses the relationship between professional and technical components in general terms.
What You Will Learn
- How diagnostic test interpretation can affect claim reporting
- How duplicate reporting concerns arise in inpatient settings
- How test review may relate to evaluation and management code selection
- How CPT component reporting is discussed for physician and facility services
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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