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Medical Billing Claims for Tests That Are Normal

Medical Billing Claims for Tests That Are Normal

If you have a medical billing claim to file and the test that was performed on the patient comes back without any definite diagnosis, don’t discount the fact that you won’t be reimbursed for the medical billing, instead you need to determine whether the test result is normal, negative, or inconclusive and that final reading will determine how your medical billing claim should be handled.

If your test comes back inconclusive, you shouldn’t report a diagnosis that the laboratory gives you after a pathology test. Many practices mistakenly report the lab’s diagnosis because they feel that claim will legitimately get paid. A good rule of thumb is to code the symptoms the patient had that necessitated the tests in the first place.

This would be pulling out the primary reason for the testing. If a patient has multiple complaints, go for the main reason they are there. A good example would be if a 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.

You should be reimbursed for the procedures you perform, make sure your medical billing claims are being filed absolutely correctly or you’re losing valuable revenue for your practice.

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