Get Reimbursed for Tests

Diagnostic testing causes a lot of confusion in medical billing. One rule of thumb when doing the billing is to only report what your documentation will support. It is tempting to report a diagnosis that comes after a pathology test because common sense would tell you that it is more likely to be paid. Instead report the reason for test and use your medical necessity such as patient complaints and symptoms to back up the reasons for the test.

Use your judgment when reporting testing and don’t use presumed diagnosis where an illness or condition is trying to be “ruled out”. Instead code the signs and symptoms the patient is presenting with and this is normally enough to get paid for the testing whether the results are normal or come back inconclusive; meaning they do not confirm diagnosis at this time.

Another way to code for testing is to pull out the primary reason for the test, if it is a simple condition such as abdominal pain in the quadrant of the body where the appendix is located. Medicare will normally pay for a diagnostic chest x-ray when a patient is having shortness of breath but they won’t cover abdominal pain. If the patient has both shortness of breath and abdomen pain, you should list shortness of breath (786.05)–the reason for the chest x-ray–as the test’s primary diagnosis if the radiologist doesn’t offer a more specific diagnosis.

Keep in mind, Medicare and many other payers allow you to report more than one ICD-9 code, so if the patient has more than one sign and/or symptom that led to the order for the imaging test, you may report all appropriate diagnosis codes.

View all Articles by: Melissa Clark, CCS-P