# Pathologist ICD-10 Coding



## Crisgo88 (Feb 2, 2018)

I have several pathologist that report diagnoses in their Pathology Report but when it comes to coding they may only list one of the diagnoses. Example #1 Three shave biopsies presented from three different body areas. One biopsy is reported as Malignant Melanoma while the other two are reported as Compound Nevus. The only ICD-10 code reported is C43.6 for the melanoma. Example #2 Pathology Report for Peripheral Blood Smear diagnosed as Thrombocytopenia and Normocytic Anemia while Peripheral Blood, Flow Cytometry diagnosed as Precursor B Lymphoblastic Leukemia. The only diagnosis coded is C91.00 for the leukemia. Is there any official guideline that states all diagnoses listed in the Pathology Report should be coded?


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## lindamurtha (Feb 3, 2018)

Very interesting. I hope someone can provide some feedback.  I am curious myself.


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## danachock (Feb 27, 2018)

*Pathology coding advice*

Hi, 
When coding pathology charges it is very important to review each specimen both the gross and microscopic when you are coding. Also this simply may be a learning opportunity for your team?? But please take the time to review each specimen and identify the appropriate diagnosis code(s). Please don't just assign "for example the diagnosis melanoma from one specimen" when three were presented for evaluation especially if the other samples are not indicated with such disease.

I will try to explain the blood smear/flow cytometry for my region. The blood smear is done in house at our Central location. The flow will be done at another location. I will share that the blood smear pathology report will actually state something similar to this "flow cytometry was performed and to review their report for additional information". The blood smear probably had code-able diagnostic issues but may have not had the findings the flow cytometry had discovered. If the pathology report is telling me to refer to elsewhere (I will review that report also) to assign diagnosis code(s). Don't just apply the one finding. Please assign all the relevant codes both from the blood smear report and the flow cytometry (ONLY WHEN INDICATED). Examples: Thrombocytopenia, anemia, leukocytosis, lymphocytopenia, leuokocytisis, red cell rouleaux, etc... 

Hoping to offer some advice.........

Dana Chock, CPC, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, Laboratory & Radiology Coder


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## fionnasmom (Feb 27, 2020)

I have been looking into our cases where I work and I've found that most of the Pathologists only use 1 ICD-10 code no matter how many actual parts there are.  Is that a regular thing?


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## csperoni (Feb 27, 2020)

Assigning the diagnoses are not based on the # of specimens, but rather the findings of the specimens.  If you have 3 biopsies, all showing the same finding, then 1 code is appropriate.  If in 3 biopsies, you have 3 different findings, then all 3 ICD10 should be coded.  Your pathologists may be lazy, too busy or (most likely) not well educated about coding.  I know many a physician that will use the code that pops up at the top of their list in the EMR when searching a term, rather than the true, accurate code.


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