Pathology/Lab Coding Alert

Question: When billing codes that fall under the physician fee schedule, should pathology billing representatives ever include the referring-provider diagnosis information such as signs and symptoms?

Codify Subscriber

Answer: If you’re billing for a pathologist, you should code the final diagnosis or results of the procedure if that information is available at the time of billing. In other words, you’ll code the diagnostic findings from the pathology report. You should not also report signs, symptoms, or non-specific diagnoses supplied by the ordering physician if the pathologist provides a more specific diagnosis.

On the other hand, if the pathology report doesn’t provide a definitive diagnosis, you should report the ordering physician’s diagnosis, such as signs or symptoms, which show the reason for the test.

There are some exceptions to the rule about reporting first the pathology diagnosis. For instance, if the physician orders a screening test in the absence of signs or symptoms of disease as a covered preventive test, you’ll need to list first the screening test diagnosis code, and list second any findings. For instance, you should report a screening Pap test with the appropriate diagnosis code, such as V76.2 (Screening for malignant neoplasms of the cervix) followed by a code for abnormal findings, if that information is available at the time of billing. Using ICD-10, you would report the screening test using an appropriate code such as Z12.4 (Encounter for screening for malignant neoplasm of cervix).