Wiki COVID19 LAB BILLING/ ICD10 CODING/ ADD DIAGNOSIS FROM RESULT REPORT BEFORE BILLING 87635

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jennamshaffer

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LAB CODERS HELP!

I WORK FOR AN INDEPENDENT LAB. THEY ARE ASKING WOULD THE LAB EVER ADD U07.1 (CONFIRMED POSITIVE COVID-19) BASED ON POSITIVE TEST RESULTS FROM THE LAB NOT THE PHYSICIAN BEFORE FILING THE CLAIM?

FOR EXAMPLE IF THE REQUISITION FORM/ LAB ORDER ONLY INCLUDED ICD10 REASON FOR ENCOUNTER CODES, BUT THE LAB RESULTS ARE POSITIVE, SHOULD/ MAY THE LAB ADD THE POSITIVE DX U07.1 PRIOR TO BILLING TO ENSURE REIMBURSMENT?

HAS ANYONE SEEN REIMBURSEMENT THUS FAR FOR CPT 87635? IF SO WHICH ICD10 CODES HAVE BEEN SUCCESSFUL? I DO HAVE THE UTD CDC GUIDELINES.

HAS THERE BEEN COVID-19 SPECIFIC ICD-10 CODES TO DESCRIBE SYMPTOMS (EX: COUGH DUE TO SUSPECTED COVID19, ACUTE UPPER RES INFEC DUE TO SUSPECT... ETC) OR ARE YOU ALL JUST UTILIZING TYPICAL/ UNSPECIFIED SIGNS AND SYMPTOM CODES (J06.9 ETC)

THANK YOU!!!
 
Laboratories report the diagnosis provided to the lab by the ordering provider on the requisition. A provider has to interpret the results and since a pathologist does not provide the interpretation and report for the positive or negative results, labs can only report what was on the order.

Our lab is seeing reimbursement, but are also finding some denials we have to work through. We have been following the guidelines, but we can only report diagnosis given to us from the ordering provider, so we will have to work with them to see if they have any other diagnoses documented in the patient record that we can add.

Official ICD-10 Coding Guidelines have been released that include COVID-19. They are much the same as the CDC guidelines.
 
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Agreed, a clinical laboratory cannot assign a diagnostic code to a patient because they are not the treating provider of that patient and it is technically outside of the scope of the laboratory. A clinical laboratory reports only those diagnosis codes reported by the ordering provider on the requisition form. Under audit and as a best practice, if there is a missing or invalid diagnosis code, the laboratory must query the physician in writing for a correction (without providing options as that would be steering), that the ordering provider then in writing with a signature and date of the correct diagnosis code and an attestation that the ordering physician has amended or included the submitted code in the patient's medical record for the date of service of the test.
 
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