# Coding after results for test is recieved



## khaspert (May 18, 2009)

Does anyone know if there are any rules against coding based on diagnostic test results for one type of test and coding before results are recieved for another type of test?

I.e. code and bill lab tests before results are recieved vs. code and bill a DEXA scan after results are recieved.

Thanks  Kim


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## ciphermed (May 18, 2009)

http://health-information.advanceweb.com/Editorial/Content/Editorial.aspx?CC=716

http://www.cms.hhs.gov/Transmittals/downloads/AB01144.pdf

Hope this helps,


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## khaspert (May 18, 2009)

ciphermed,  

I had read this same transmittal but I'm not sure what it says.  I am under the impression that you can code diagnostic testing as the ordering physician and interpreting physician with symptoms before you have the results.    Does this say that you should always code any diagnostic testing only after the results are recieved if you are the ordering and interpreting physician?


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## pamtienter (May 18, 2009)

Kim, Check out the Official ICD-9 Coding Guidelines. Page 29 might help. That has info about coding diagnostic tests in the office.

http://www.ama-assn.org/ama1/pub/upload/mm/362/icd9cm_coding_guidelines_08_09_full.pdf


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## khaspert (May 18, 2009)

Thanks for your response.

It still is not clear whether it is acceptable to hold coding until the test has been interpreted and if it is, can you hold the coding for one and not the other?

Sounds like this is a tuff one to answer for all.  My gut tells me that we should probably be consistant and either code all diagnostics testing one way or another.


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## LTibbetts (May 28, 2009)

I would query the physician first. For outpatient, you can NOT code any lab, test results unless documented by the physician. We hold our charts up here until we receive the path's. If they come back positive or with any result other than what they were tested for in the first place, then we query. We still always go by "If it isn't documented, we can't code it." Is this what you mean? If not, what is the test you are coding for? Maybe that would help determine what our advice would be.


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## mitchellde (May 28, 2009)

It seems difficult because the answer lies in what type of job you do.  First no coder may use a lab result for a dx code.  Labs have not been interpreted by a physician so you code the symptoms or screening or drug monitoring.  For Physician and outpatient coders you are required to wait for the path report for skin lesion excisions for the the dx code, the diagnosis in this case is rendered by a physician so the coder may use the report.  All other diagnostic tests, for physician coders you may use what you know at the time of coding or you may use the diagnosis rendered on a path or radiology report.  Hospital inpatient coders may not code from path reports or radiology reports, they are required to wait until the physician renders a dx in the progress notes or discharge summary.  I hope this helps clear things up a bit.


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## khaspert (May 28, 2009)

*coding labs*

This is a primary care practice with our own lab. We also do our own DEXA scans.  The question arose when one of my coders asked me whether we could code our dexa's after the results come back since some of them may have a dx of osteoporosis after the interpretation vs. using a screening code.  I am a little hesitant to allow this since we always code our labs internally with before they are interpreted.  My question really is, is there a rule against coding one type of diagnostic testing before interpretation and one type after?


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## mitchellde (May 28, 2009)

Ah  in the coding guidelines you will find your answer... When the test or exam is for screening purposes , then the V code for screening remains your first listed dx code regardless of the findings or any subsequent procedure performed at that setting.  You may list the finding as a secondary code if the test is for diagnostic purposes because the patien has symptoms, then you may use the definitive finding as your first listed dx.


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