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Diagnostic Testing - Articles

HCC - Acceptable Provider Interpretation for Diagnostic Testing
October 1st, 2018 - Wyn Staheli, Director of Research
The following table is taken from the Contract-Level Risk Adjustment Data Validation Medical Record Reviewer Guidance dated 2017-09-27 (see References). It is a listing of acceptable provider interpretation of diagnostic testing. Acceptable Examples include: Cardiology and Vascular Surgeons Echocardiogram (including Doppler, Duplex, Color flow of the heart vessels) EKG (electrocardiogram) – Stress test, Cardiac ...
All About Screening and Diagnostic Mammograms
March 17th, 2015 - George Lawson
When billing for mammograms, documentation must include the purpose and the result of the procedure. Two major purposes of mammogram are diagnostic and screening. It can also be used mammography to guide other procedures. Tip 1: Confirm the Purpose Determine the purpose of the procedure; i.e....
Preparing for ICD-10
February 25th, 2013 - Codapedia Editor
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Supervision Requirements for Diagnostic Tests
July 17th, 2009 - Codapedia Editor
Medicare has specific physician supervision requirements for diagnostic tests. Each CPT® code that represents a diagnostic test is given a supervision indicator in the Medicare Fee Schedule. From Chapter 15, of the Medicare Benefit Policy Manual describes these levels of supervision: General...
Screening Diabetes tests for Medicare patinets
March 31st, 2009 - Codapedia Editor
The Medicare Modernization Act of 2003 added a benefit for Medicare patients for services provided after Jan 1, 2005. Medicare added coverage for screening Medicare patients for diabetes, if the patient has an individual risk for diabetes. There are diagnosis and frequency limitations. The...
Modifier 26
March 21st, 2009 - Codapedia Editor
Modifier 26 is a CPT® modifier used to indicate that the physician practice performed the professional component only of a diagnostic test. There is no CPT® modifier for the technical component. The facility that performs only the technical component uses a HCPCS modifier, TC. Some...
Diagnostic test interpretation
March 21st, 2009 - Codapedia Editor
Many-- but not all-- diagnostic tests are composed of a technical and a professional component. These tests are identified in the Medicare Physician Fee Schedule. When the physician practice performs both components, the service is billed globally, with no modifier. If the technical component is...
Report for professional component of a diagnostic test
March 12th, 2009 - Codapedia Editor
What does a physician need to document and in what format? If you are a radiologist, you know the answer to this question. Many diagnostic tests have both a professional and a technical component. Whether or not a test has both is found in the Medicare Physician Fee Schedule Data Base. A...
PPD Testing
March 3rd, 2009 - Codapedia Editor
To bill for placing the purified protein derivative (PPD) skin test,use CPT® code 86580. Use this code when the nurse or medical assistant places the test on the patient's skin. The CPT® definition of the code is: Skin test, tuberculosis, intradermal. The code has a technical component...

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