What is the legal implication for billing for the procedure


Problem: Dr. Cutup with Sinclair General Surgeons performed a placement of an external infusion pump on a Medicare patient, but the patient did not meet any of the criteria for coverage based on the NCD. Dr. Cutup has instructed you, the medical biller, to go ahead and bill the procedure anyway using a diagnosis that would be covered under Medicare. Unfortunately, the medical record does not document the patient with that condition. What is the legal implication for billing for the procedure using the diagnosis Dr. Cutup gave you?

 

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