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The page below is a sample from the LabCE course Medicare Compliance for Healthcare Personnel. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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International Classification of Disease (ICD) Coding

ICD codes are used for the classification of diseases and conditions, and for describing signs, symptoms and medical circumstances. These codes are used to indicate the medical necessity of a particular test. All employees who are directly or indirectly responsible for reporting to Medicare must be aware of these guidelines to prevent fraudulent claims:
  • ICD codes can only be supplied by the ordering physician or a representative of that physician.
  • If the patient is undergoing a test or procedure, ICD codes cannot be used from a previous patient order.
  • If a physician supplies a narrative description instead of an ICD code the service provider must accurately translate that code using only certified coders.
  • It is against the law to use the wrong ICD code for the purpose of causing or increasing payment for a test.