Pathology/Lab Coding Alert

Report the right code -- every time

The key to payment may be your ICD-9 code--so choose it wisely.

Whether the ordering physician gives a narrative diagnosis or your pathologist makes the final call, you could find yourself assigning ICD-9 codes. That's why you need to clear up the following common misconceptions.

Myth: You can only bill one diagnosis code.

Fact: Based on physician documentation, you should bill as many diagnosis codes as you need to establish medical necessity for the services you-re billing, says Dianne Wilkinson, RHIT, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn.

Some payers- computer systems used to be able to read only one diagnosis code per line, but now you should always be able to report all pertinent diagnoses and link the correct diagnoses to each service on each line.

Myth: When you don't have enough information to choose a specific four- or five-digit code, you can report the general three-digit code instead.

Fact: You must report codes to the highest degree of specificity. That means you have to use four- or five-digit codes when available. You should never report a category (three-digit) or sub-category (four-digit) code when ICD-9 lists more specific codes under those headings. In fact, the ICD-9 code book marks category and sub-category codes with a symbol that says -34th- or -35th- to indicate that you should not report that code--it requires a fourth or fifth digit.

If you don't have specific information, you should choose the four- or five-digit code that says -unspecified- or -not otherwise specified- (NOS), or -other.-

For instance: If the pathology report indicates a non-adenomatous nasal polyp with no further information, you should report 471.9 (Unspecified nasal polyp) rather than 471.x (Nasal polyps).

Myth: V codes don't pay anything, so there is no reason to use them.

Fact: While it's true that some V codes are only descriptors that give background information on the patient, the information that V codes provide can help support medical necessity for lab tests.

For instance: A patient taking Celebrex for her arthritis needs to have her liver and kidney functions monitored to make sure the drug is not causing any problems. The patient, who is otherwise healthy, undergoes lab tests every few months to monitor kidney and liver functions.

In this case, a V code that shows the patient is on a drug long term such as V58.64 (Long-term [current] use of non-steroidal anti-inflammatories [NSAID]) will help to substantiate the need for these tests to the patient's insurance carrier. Without it, the tests appear medically unnecessary.