This course provides an overview of coding and reporting guidelines for diagnostic and screening services. It will cover documentation requirements and medical necessity criteria that help differentiate between screening and diagnostic services. The information in this lesson applies to facility-based outpatient coders, billers, and revenue cycle managers. This lesson will include outpatient coding information using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes and guidelines. ICD-10-CM codes establish medical necessity by communicating the reason for the screening or diagnostic exam. Learners should have a basic knowledge of facility-based outpatient coding and/or billing regulations before completing this lesson.
This activity is approved for 0.5000 contact hours.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
Section 1: Introduction
About This Course
Section 2: Definitions
Differentiating Between Screening and Diagnostic Services
CMS Definition of Diagnostic Services
Section 3: Guidelines
ICD-10-CM Coding and Medical Necessity
Outpatient Coding Guidelines
Coding Guidelines for Screening Services
Coding Guidelines for Diagnostic Services
Coding Examples for Diagnostic Services
Section 4: Documentation
Other Sources of Documentation
How Documentation Supports Screening vs Diagnostic Reporting
Relationship of High-Risk Criteria to the Coverage of Screening Exams
Frequency of Screening Exams
Section 5: Conclusion
Alison has twenty-nine years of healthcare and information system experience, eleven of those years consulting at hospitals across the United States. Her areas of expertise include all aspects of Soarian Financials Revenue Management including Service Catalog (CDM), Service Maps, CRDT, General Ledger, Contracts, Claims, Reports, and all Master Files. Alison has provided analysis and reconfiguration for optimization, new build services, legacy support for hospital systems moving to a new platform, and training.Disclosure: Alison Kazmierczak has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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