How to Code and Bill Diagnostic Tests

In order to report 93000, a required separate report would be prepared and available in the medical record. The report should identify the reason for the EKG, relevant clinical issues, finding and any comparative data when available.

Both CPT and CMS coding and payment rules address the need for a separate written report. CMS has expanded the guidance identifying that the report should contain the level of detail a specialist in the field would document.

How to make sure your urgent care center is compliant? Determine the best method in your facility for achieving the documentation requirements including specific views, type of test, reason for test, location of the X-rays, and professional interpretation. If you are using an electronic medical record have your vendor create a section for X-ray, EKG reports and other diagnostic tests that will electronically hyperlink to the report even if the documentation is produced in the body of the E/M services. 

Summary

Key points to keep in mind:

Remember the professional interpretation and report does not need to be performed by a radiologist or another specialist in the field. The AMA has clearly identified that payment or coding should not be based on specialty and should not be restricted based on specialty code.

You can get credit for your medical decision making for deciding to order the diagnostic test/X-ray as well as report for the diagnostic test provided in the facility.

A radiologist may be employed by the urgent care center or may be a contractor who is reimbursed based on contract. It is up to the facility how the billing is performed. The radiologist may bill for his/her own services, or the facility may pay the radiologist and bill the global component. There should be a definition of how coding and billing is performed when contracting with an outside radiologist.

Make sure documentation supports a separately identifiable report when reporting the interpretation and report for any X-ray or diagnostic test performed in the urgent care setting.

When reporting the diagnosis, keep in mind report the confirmed diagnosis based on the report findings (if known) with any signs or symptoms reported secondary.

If the diagnosis is not confirmed or the test is normal, report only sign and/or symptoms.

Deborah Grider, CPC/EM, CPC-I, CPC-H, CPC-P, CCS-P, is a healthcare consultant and president of the American Academy of Professional Coders (AAPC) National Advisory Board. AAPC provides certified credentials to medical coders in physician offices, hospitals and outpatient centers.

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