Entering Diagnosis Codes

During order entry, you may associate up to eight diagnosis (or ICD) codes with each order choice that you select.

If you have enabled the option in Harvest that requires users to enter diagnosis codes, then Harvest Webstation will not allow you to place an order without entering a diagnosis code. See the Harvest online help for more information.

You may also edit the diagnosis codes prior to saving the order.

Validating Diagnosis Codes

Harvest, accessed through Harvest Webstation, is able to validate the diagnosis codes entered for a patient's order. This process is also called an ICD check or a reimbursement check.

Harvest can use the results of this comparison to flag order choices that may not be reimbursable by the patient's insurance company. Insurance companies may not reimburse testing if the supplied diagnosis codes are not considered valid, if ordering frequency limits are exceeded, or if the order choice is marked "Research/Experimental." See the Harvest online help for more information.

In these cases, Harvest Webstation prompts you to print an Advance Beneficiary Notice (ABN) for the patient to sign as acknowledgment that some testing may not be covered by insurance.

This validation process, which is outlined below, occurs automatically if you have the appropriate preference, insurance, and order choice settings in Harvest. See the Harvest online help for more information.

1. Enable the Harvest Webstation preference that requires diagnosis code entry, if desired. This setting, established in Harvest, is selected by default. When enabled, Harvest Webstation will not allow you to save an order unless each order choice has an assigned diagnosis code. Note that if this setting is turned off, then no validation of diagnosis codes will occur.
2. Enter an order for the patient, assigning one or more diagnosis codes to the order choices.
3. As you continue to the second order entry page, Harvest Webstation determines whether or not it will perform a reimbursement check.
4. When Harvest Webstation performs the reimbursement check during order entry, it will first verify whether the patient's insurance company enforces ICD checking.

For those companies with ICD checking enabled, Harvest Webstation will then verify whether or not conditional ICD checking is enabled.

• If it is enabled, it will determine whether the patient, order, or draw location for the order should trigger reimbursement checking, based on the settings in the Enforce ICD Checking by Location window in Harvest.
• If it is not enabled, Harvest Webstation will perform the reimbursement check, regardless of the patient, order, or draw locations.

If insurance companies do not have ICD checking enabled or if ICD checking is enabled for the insurance company but the conditional ICD enforcement settings do not trigger ICD checking, then Harvest Webstation will not perform the reimbursement check for those orders.

If the "Enable ABN checking with no insurance" preference is enabled in Harvest, Harvest Webstation will perform reimbursement checking to flag ABNs for patients who do not have insurance enabled. Conditional ICD checking settings do not affect these patients’ orders.

5. When the second order entry page appears, Harvest Webstation displays the diagnosis codes in one of three colors, based on whether or not the diagnosis codes are valid for the order choice:
• Red: The diagnosis code is invalid. Invalid diagnosis codes usually require an Advance Beneficiary Notice (ABN).
• Blue: The diagnosis code is valid. A diagnosis code was found for the order choice that matched the insurance type of the patient's insurance company or that matched the "All Insurance Types" category.
• Black: Harvest does not have information in the Order Choices table to determine if the code is valid or invalid (i.e., there are no diagnosis codes associated with the order choice for the patient's insurance type). The ABN dialog box will not be triggered in this situation.

If the patient's insurance company does not enforce ICD checking, then Harvest Webstation still displays the diagnosis codes in valid or not valid colors, but the ABN Status will be "Not Applicable" and will not be enforced. You may continue to save the order.

6. If Harvest Webstation performs reimbursement checking, it compares your entries to the valid diagnosis code, frequency, and research/experimental settings that were set up for the order choices in Harvest. If necessary, it creates ABNs as follows:
• If the diagnosis code, frequency, and research/experimental settings for an order choice are valid and the insurance company enforces ICD checking, then the ABN Status is "Not Applicable" and you may continue to save the order.
• If one or more diagnosis codes for order choices are not valid and the insurance company enforces ICD checking, then you will be prompted to print an ABN form for the patient to sign before you may save the order. If the patient's insurance company is set up to use the Medicare format ABN, you may also select the option to print the Medicare ABN in Spanish, if desired.
7. The contents and format for the ABN depend on the following:
   • Harvest Webstation will use the Medicare format for ABNs if the patient’s insurance company has the Medicare format option enabled.
   • Harvest Webstation will use the non-Medicare format for the ABN if the Medicare format option is not enabled or if the ABN is for a patient with no insurance.
   • If the order contains one or more order choices with invalid diagnosis codes, then Harvest Webstation lists the ICD code violations in the first column of the form.
   • If the frequency limits are exceeded for the combination of the order choice and the insurance type belonging to the patient, then Harvest Webstation lists the frequency violation in the second column of the form.
   • If the order choice is designated as experimental or for research, then Harvest Webstation lists the research/experimental order choice in the third column of the form.

You may modify your advanced configuration options to use the current user's linked draw or order location and phone number in place of the practice name and phone number on ABNs. It will also appear in the title of the browser and at the top of the page. If the options are enabled but the current user does not have a linked draw or order location, Harvest Webstation will print the practice/lab name, address, and phone number from the General tab of Web Preferences in Harvest. Note that if the advanced configuration option to put the second address line at the end of the address is enabled, Harvest Webstation will place the second address line after the city/state/zip line when displaying the practice/lab address.

You may use an advanced configuration option to append pricing text to each order choice included on an ABN. If this is set, Harvest Webstation will append the defined text to the order choice after the CPT code.

See the Harvest online or printed help for more information.