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CodeMap Compliance Briefing: 6/06/03: Diagnosis Coding Rules

Editor's Welcome:

Our topic this week is ICD-9 coding rules for providers of diagnostic tests, including radiologists and pathologists. Primarily we will determine how providers should choose the diagnosis code(s) that are used to submit claims to Medicare and Medicaid. Please note that the rules discussed today apply to radiologists and pathologists, not clinical laboratories. Next week we will review diagnosis coding rules for clinical laboratories. As you will see, the rules differ depending on the type of provider. As always please do not hesitate to forward questions, comments, or suggestions for future CodeMap Compliance Briefings.  

Sincerely,

Gregory Root, Esq.

Rule 1: How to Choose ICD-9 Codes When Procedure Establishes Diagnosis.

If the radiology or pathology procedure results in a diagnosis, the radiologist or pathologist should use the ICD-9 code that best describes that diagnosis.

Example A: A patient is referred to a radi....

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