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.