Good Morning:
I recently had a discussion with a facility MIS Director regarding the appropriate diagnosis code when a study is negative ( this email is referencing hospital outpatient, negative studies for DVT for which no other signs or symptoms are available in the hospital records). We most commonly see this issue for LE venous duplex scans, however we also encounter this for other studies/diagnoses. This facility educated their referring physicians that "rule out" is not appropriate. The result is we are now commonly seeing "Deep venous thrombosis" in the Indication or reason for exam and the facility is utilizing that diagnosis code for billing. The director went further to state they (the referring docs) aren't using rule out, they (the hospital) doesn't interpret the report, they aren't getting denied, and hospital billing is different so they are correctly coding. I explained they aren't 'interpreting' but are coding the report when they assign a DX code. I also referred the Director to Chapter 23, Section 10.3 Outpatient Claim Diagnosis Reporting of the Medicare Claims Processing Manual regarding if no diagnosis can be made, then a sign or symptom should be coded.
I am hoping someone can give me additional materials I may use to convey our dilemma in an effort to educate the facility if the study is negative, we must have a sign or symptom in order for the reading physician to be paid.
Thanks in advance,
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Dorothy Henslee
Millennia Information Systems LP
Denison, TX 75020
903-465-1857
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