Wiki final diagnosis

[annettebec]

Can anyone out there tell me how you are handling filing a claim for pathology cases. I was trained to wait for the final pathology report before filing a claim. Do you charge from the requisition or do you charge from the pathology report with a definitive diagnosis. Also, do you have any documentation to back up the process you are using. I was trained that it is non compliant with Medicare to file a claim without the definitive diagnosis from the pathology report. If there is no definitive diagnosis, I was trained to use clinical signs and symptoms. Any help appreciated. Thanks

 

[bbooks]

You are correct. I work for a pathology group and I code the surgical pathology. Coding should wait until the diagnosis is made by the pathologist. The practice of coding signs and symptoms if there is no pathology to record is confirmed in Dennis Padget's "Pathology Service Coding Handbook." For example, sometimes a colon biopsy is submitted, but the path report shows it at normal mucosa. In that case, you would code either the patient's signs and symptoms or a screening code as appropriate.