Gastroenterology Coding Alert

You can unlock the mystery behind ordering and reporting diagnosis codes for laboratory work by dispelling two long-standing myths.

Many coders do not think they can bill for the procurement of blood samples for laboratory work. Also, many gastroenterology coders believe that the laboratory can provide the diagnosis code to use for billing purposes from the results of the test. These beliefs are misguided because under certain circumstances physicians can report services performed related to diagnostic lab tests, and a physician must be the one who provides appropriate diagnosis codes for laboratory tests.

Myth 1: Physicians cannot bill for any part of lab testing. Sometimes tests can be taken in the doctor's office and sent to a laboratory for analysis, or a physician may have an in-house lab. For example, a physician or nurse draws blood to be sent to an outside lab. You would report 36415* (Collection of venous blood by venipuncture). Simple tests could be performed in the office, such as a urinalysis. In this case, you would code from the 81000-81099 series for urinalysis tests done in-house.

Myth 2: Laboratories can supply the diagnosis code. Medicare Program Memorandum AB-01-144 dispels this myth and substantiates the idea that you must report a diagnosis to the highest level of certainty. A diagnosis code cannot be assigned by the laboratory unless a physician interprets the results of the test. If the results of the test are normal or do not provide a diagnosis, then you would code the symptoms and signs that prompted the test. You should not list incidental findings as primary diagnoses. Also, when you report a test and results have not been received, you code for signs and symptoms. The ordering physician is responsible for providing the reason for the test, including documentation in the medical record.