Pathology/Lab Coding Alert

"Diagnosis coding for laboratory work can often prove challenging for pathology coders. Questions arise about whether the ICD9 Codes should be assigned based on test results or the reason for the test, whether screening or signs and symptoms prompted the test. There is also debate about who should assign the ICD-9 code the requesting physician or the laboratory coder.

Because correct diagnosis codes are the key to adequate reimbursement for lab-oratory tests, the treating physician must provide at least a narrative description of the reason for the test, and the ICD-9 code should be assigned to the highest degree of certainty available at the time of billing.

It is difficult for coders to know what to do because there is conflicting information in writing, says Barbara J. Cobuzzi, CPC, MBA, CHBME, president of Cash Flow Solutions Inc., a physician practice billing company in Lakewood, N.J.

Assigning the correct diagnosis code for tests and laboratory work is particularly important because Medicare doesnt cover preventive screening or services in most cases, Cobuzzi says. Items and services not deemed reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member, are excluded under Medicare Part A and Part B. That means coders must understand when a test is not a screening, and how proper diagnosis coding can affect appropriate reimbursement.

Screenings are usually performed during annual exams, Cobuzzi says. The patient comes into the office with no problems or complaints, and the physician runs some tests to make sure there are no underlying illnesses that are being missed. The physician and the patient didnt think anything was wrong when the test was ordered, and if nothing is wrong, the screening code is used. Paradoxically, if the test uncovered a medical problem, the diagnosis code for the problem would justify the medical necessity of the test, Cobuzzi says. However, other people would disagree with this interpretation and claim that if the test was ordered for screening, that the screening code must be used.

What about the instance of a patient who presents with an unknown problem, and tests are ordered to help determine the cause of the complaint? The diagnosis should reflect the presenting signs and symptoms rather than a screening code. The test is considered diagnostic rather than screening even though no illness is found, Cobuzzi stresses. The patients subjective complaint is sometimes the only thing you have. Its the reason the patient came to you and the reason the test was ordered.

Diagnosis Coding When Test Is Negative

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