Pathology/Lab Coding Alert

New, specific ICD-9 codes for "pre-op" and other laboratory examinations will make your job easier -- right? Wrong.

"If physicians start to order laboratory tests using just a V code for pre-surgical testing instead of listing condition codes that indicate medical necessity for the tests, you can expect to get denials," cautions William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Historically, many payers haven't paid for lab tests ordered with V72.6 (Laboratory examination) and no other documentation regarding the reason for the test. Now ICD-9 2010 replaces V72.6 with five new five-digit codes:

• V72.60 -- Laboratory examination, unspecified

• V72.61 -- Antibody response examination

• V72.62 -- Laboratory examination ordered as

• V72.63 -- Pre-procedural laboratory examination

• V72.69 -- Other laboratory examination.

These codes add specificity to reporting encounters for serologic antibody testing, or encounters for lab tests that are part of pre-procedure preparation or part of a general physical exam. Currently, ICD-9 provides similar V codes for pre-procedural cardiovascular and respiratory evaluations, as well as a code for other preprocedural examinations, but not for laboratory exams.

The expanded V72.6x codes allow you to more specifically report the reason for the encounter. But they don't provide any information about the patient's condition or signs and symptoms that prompted the need for specific tests.

"If you perform diagnostic lab tests based solely on one of these new lab exam codes, Medicare and other payers will likely consider them screening tests and decline to pay," Dettwyler says.

Action: Because the ordering physician, not the laboratory, assigns the ICD-9 code, you'll need to help your physician clients understand how they should and shouldn't use the new codes, Dettwyler says. V codes describe the reason for the encounter, but physicians should still use specific condition codes to describe the signs, symptoms, or disease that show(s) medical necessity for ordered tests.