ICD codes and labs and the law

[tiroka03, LPN]

What is the answer? I am totally dumbfoggled over this. Part of my responsibilites is to place the orders for labs. Each one requires an ICD code. Most of them are easy fits. But almost every night there are a few that completely stump me. Nothing seems to work.

I have heard that a couple nurses lately have gone to court over Medicare fraud and ICD codes. I don't want to be in that boat, - just by trying to find a code that will push the lab throuigh. I look through all the diagnosis's and every way I can think of to make it work. But, it's the middle of the night and there is no one to call,and the lab people are not helpful.

Am I getting too sensitve? There are some labs I have put a call in to the doc to get a code as the test doesn't support any diagnosis. I have asked the nurses who take the orders to get a code from the ordering doctor if the test is unusual. No one seems overly interested in helping, and I am fast becoming frustrated.

I am afraid that if I just put a working code for a lab, no matter the diagnosis that it consitutes medicare fraud. What is it that helps you?

[green217]

There should be a medical coder in your facility, if not, the nurses must be trained on the basics of medical coding. Yes, the lab requires codes. Sometimes, nurses will put any "good enough" code so the lab can be done. However, chart auditing has evolved. They look at the codes and if you have the wrong codes, the procedure will not be reimbursed... or the reimbursement will have to be returned.

You can train yourself how to code just for your own peace of mind, but really, the facility needs to get someone to handle the coding!

[merlee]

People who get arrested for fraud have a history and are usually part of a group that will benefit from the fraud. It would be difficult for you personally to benefit from an inadvertant inappropriate code.

But the doc should be providing the code whenever possible.

[KateRN1]

Yup. If doc writes an order for labs, s/he should be including diagnosis or suspected diagnosis. If the nurse is taking a verbal/phone order, s/he needs to ask what diagnosis this is referencing. I'm not sure of your practice setting, but sounds like you need a new policy/procedure in place.

[elprup, BSN, RN]

We used to have this problem at our clinic. Recently we went electronic medical record and now the providers have to link an ICD9 Code to any lab before they can order it. OMG the first month the providers were up in arms stating how hard it was to find right one. It was really eyeopening for the providers to see all the running around MA's had to do with no formal medical training. I think our providers should have been doing ICD9's from the begining because i found many ICD9 codes that were severely incorrect (like stating a pt had cancer!) A total liability because those diagnosis do not got away easily.

[classicdame, MSN, EdD]

medical coding requries lots of education done on a frequent basis. The MA may not have the medical background to totally understand the purpose of the procedure and the MD does not have the time for what they consider to be clerical work. Professional coders, or software, is a better answer. Remind the doc that we are talking about his income.