Question

In determining the most appropriate procedure per specimen, per case, sometimes knowing the organ or anatomic site is not enough. Many organs are listed under multiple pathology codes, with the some on every level of service. This coding does not account for specimens that are more involved to diagnose. Explain what documentation could help better tell the “story” of what all was completed for the pathology that could lead to better reimbursement covering the services rendered. Include what can happen if the "story" is not good enough and the effects it has on the patient.

Answer 1

a physician or other qualified health care professional documentation, should clearly indicate all the diagnostic lab tests and management of patient conditions. don't include tests that are not ordered but he physician or other qualified health care professionals. documentation must include the progress notes or office notes signed by the physician and other qualified health care professional and their order/intent to order, laboratory results, lab codes with professional component / technical component indicator should be included in the reimbursement stories. modifiers 59,90,91,92,XE,XP,XS,XU may help for reimburse the service provided. modifier 59 should not be used when a more descriptive modifier is available. CPT codes should not be reported in conjunction with other CPT codes. if any incorrect modifiers or CPT codes entered or used, it impacts patient's treatment and service they receive and it causes issues in reimbursement.