Pathology/Lab Coding Alert

 Know the ICD-9 table and terminology to get the code right When the pathologist renders a narrative cancer diagnosis based on the tissue exam, you may have to assign the ICD-9 code. Nailing down the neoplasm diagnosis is critical for reimbursement. Follow these five  expert tips to produce correctly coded claims every time. Tip 1: Don't Make a Move Without the Path Report Don't even try to choose a neoplasm diagnosis until you've received the results of the pathology study. Don't code based on a "suspected" or "rule-out" diagnosis that the ordering physician may submit.
 
"Without the pathology report, you're just guessing what kind of neoplasm you're dealing with," says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting in Landsdale, Pa. Even if the ordering physician has a strong suspicion that the growth is cancerous, for instance, the diagnosis is still unconfirmed until you get the pathology results.
 
Entering the wrong diagnosis can have serious effects. You don't want to label a patient as having cancer if the diagnosis isn't certain, says Darren Carter, MD, president of Provistas Inc. in New York City. A cancer diagnosis is a red flag for insurers that could make it more difficult for the patient to gain medical coverage.
 
However, failure to indicate a malignant lesion when present will limit the coding for the current procedure and can also limit the treatment options that the insurer may accept at a later date. 
 
Bottom line: Choosing a diagnosis is hard enough, so be sure you have all the relevant information before you proceed. Tip 2: Identify the Type of Neoplasm With the pathology report in hand, first determine if the neoplasm is benign or malignant. If it's malignant, you'll have to identify the type: primary, secondary or     in situ (see "Decipher Malignant, In Situ and Uncertain" on page 47 for more on the different types of neoplasms). 
 
"A pathology report usually clearly identifies the type of neoplasm," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. "Using this information, you're ready to go to ICD-9 and find the diagnosis code that fits." Tip 3: Consult ICD-9 Volume 2 Next, you should go to the alphabetic index (volume 2) of the ICD-9 manual and look up the main term that describes the neoplasm type, such as melanoma or lymphoma or adenocarcinoma.
 
Don't skip to the neoplasm table: Although the alphabetic index will often direct you to the neoplasm table, checking the index is not a wasted step. [...]