Allergy Coding Alert
Reader Question: Posttest Diagnosis
Question: When providing a diagnostic test, can I report a posttest diagnosis confirming the presence of the condition for which the test
was performed?
Kansas Subscriber
was performed?
Kansas Subscriber
Answer: CMS has ruled that it is appropriate to report a posttest diagnosis confirming the existence of a suspected condition. CMS transmittal AB-01-144 (Sept. 26, 2001) clearly specifies, If the physician has confirmed a diagnosis based on the results of the diagnostic test, the physician interpreting the test should code that diagnosis. In addition, The signs and/or symptoms that prompted ordering the test may be reported as additional diagnoses if they are not fully explained or related to the confirmed diagnosis. If the test does not confirm a diagnosis, only the signs and symptoms prompting the test may be reported.
Diagnostic screenings are still not reimbursable by Medicare, even if the screening confirms the existence that requires additional treatment. For screenings absent signs and symptoms, report the appropriate screening code (e.g., V81.4, Special screening for other and unspecified respiratory conditions). Any conditions discovered as a result of the screening may also be reported but will not provide medical justification for the test.
Note: For more information on CMS transmittal AB-01-144 and its importance, see Allergy Coding Alert, Fourth Quarter 2001.
Clinical and coding expertise for You Be the Coder and Reader Questions provided by Teresa Thompson, CPC, an allergy coding and reimbursement specialist in Sequim, Wash.
- Published on 2002-03-01
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