Pathology/Lab Coding Alert
Get Ready for Summer Fun That Sends Lab Test Orders Your Way
Rashes and bites and burns, oh my! With people spending more time outdoors this season, your lab might see an uptick in procedures to diagnose conditions caused by fires, allergens, ticks, and more. Read on for some procedure and diagnosis tips that can ease your summertime coding. Focus Your Lyme Disease Coding Insect bites may be a simple summer nuisance, but sometimes they produce inflammation or other symptoms, or even result in serious conditions such as Lyme disease. If you get orders for a lab test related to an insect bite, “there are over 350 diagnoses that could relate,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. For instance: If the bite is from a tick and the patient develops symptoms such as fever, rash, and muscle aches, the clinician may send a blood specimen to your lab to get a test for suspected Lyme disease. Antibody: The Centers for Disease Control and Prevention (CDC) recommends two-tiered testing for Lyme disease to find an antibody marker for the causative agent, Borrelia burgdorferi. The initial recommended test is an enzyme-linked immunoassay (ELISA) for B. burgdorferi antibody: 86618 (Antibody; Borrelia burgdorferi (Lyme disease)). The test is highly sensitive and may result in false positives. That’s why the CDC recommends the second test, which is highly specific, that you would report as 86617 (Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot)). If both tests are positive, it indicates that the patient has been infected with the organism and developed antibodies to it. Those findings are considered positive for a Lyme disease diagnosis. Antigen: Although CPT® provides the following codes for antigen testing, concentration of B. burgdorferi antigens in blood is low, resulting in low test sensitivity for nucleic acid techniques: The tests may be more effective using a joint fluid specimen, but that leaves the less-invasive antibody test — the preferred testing modality for a Lyme disease diagnosis. PLA: You’ll also find the following proprietary laboratory analyses (PLA) codes for B. burgdorferi detection. These codes apply to only one unique lab test that you may purchase from a specific manufacturer or send off to a specific lab for performance. Diagnosis: Using clinical factors and positive test findings for B. burgdorferi, the clinician will assign one of the following diagnoses: The appropriate secondary ICD-10-CM code for the tick bite is W57.- (Bitten or stung by nonvenomous insect and other nonvenomous arthropods). Account for Skin Infection Testing Physicians may see an uptick in rashes due to plant contact during the summer. When those rashes get infected, your lab may see increased testing requests, too. For instance: The physician sends a swab for microbiology from a patient with a poison ivy rash that has formed a lesion with pus and redness. If you have just the narrative diagnosis, you can assign a diagnosis code based on the description. ICD-10-CM does not indicate plant type, so you should select from L23.7 (Allergic contact dermatitis due to plants, except food), L24.7 (Irritant contact dermatitis due to plants, except food), or L25.5 (Unspecified contact dermatitis due to plants, except food). If the rash is causing “significant issues such as infections on the skin, you would use L23.7, the code for allergic contact,” says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting, Inc. in Lansdale, Pennsylvania. Scenario: The lab analyst performs a direct smear of the lesion swab and reports the presence of Gram-positive bacteria to the clinician, then cultures the swab. Days later, the culture returns a presumptive identification of Staphylococcus, and the lab performs coagulase testing to definitively identify S. aureus. Coding: Report the Gram stain on the direct smear as 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types). The lab immediately reports these findings to the ordering physician, who may want to begin antibiotic treatment before the culture results are available, according to William Dettwyler, MT AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. You should also report the quantitative aerobic culture and definitive identification using the following two codes: Final Dx: Based on clinical and lab findings, the physician may report the final diagnosis code as L08.89 (Other specified local infections of the skin and subcutaneous tissue) and a secondary diagnosis of B95.61 (Staphylococcus aureus infection NOS as the cause of diseases classified elsewhere). Run Labs for Severe Burn Patients Summer burns may come in many flavors, from minor sunburn to severe burns from a campfire or housefire. Because serious burns can cause problems with blood gases, electrolyte concentrations, and metabolic imbalances, physicians may order a wide array of clinical laboratory tests for burn patients. For instance: Clinicians will probably monitor blood oxygen levels and order carboxyhemoglobin to evaluate for carbon monoxide poisoning. Severe burns almost certainly require basic lab testing and prep for possible transfusion, such as complete blood count (CBC), type and crossmatch. The physician may also request sodium, potassium, and calcium testing to monitor electrolyte balance. Search panels first: Before resorting to individual chemistry codes for some of these tests, you should look to see if what the physician orders is covered by a panel test code, such as one of the following: Caution: Don’t use a panel code unless the physician orders every one of the tests listed in the code. If not, you’ll need to separately list the code for each test. Labs can facilitate ordering and coding by having panel tests as options on the requisition. CBC: If the physician orders a CBC (not as part of the general health panel), you may report the test one of the following ways, depending on how the lab performs the work: For blood gases you’ll turn to one of the following codes: Decode: Here’s what the various components of blood gas measurements mean: To identify carbon monoxide (CO) poisoning, labs run one of the following tests:
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