TMPPM 2008 > Texas Medicaid Services > Independent Laboratory > Benefits and Limitations

26.4.12 Diagnosis Requirements

Independent laboratories and pathologists do not have to supply the Texas Medicaid Program with a diagnosis except when billing the following procedures:

Claims submitted for the above procedures without a diagnosis are denied. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) evaluation and management (E/M) codes must not be used as the primary diagnosis.

All V codes except those listed under "Coding" may be used as a primary diagnosis if appropriate. Additionally, any laboratory services provided to clients eligible for emergency services only must have a diagnosis on the claim to ensure accurate claims processing.