Wiki matching dx codes on outpatient surgeries

Colliemom

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I recently had a physician ask the following question:

How crucial is it that the post-op findings of the surgeon and the facility match?

What is your opinion? There are occasions when the surgeon submits his/her findings (postoperative dx) immediately after completing the surgery. The hospital may have a delay in submitting their facility charges for the surgery. Which means the pathology report, which wasn't available until 5 days after the surgery, can effect what dx code the hospital bills. (while the surgeon, who submitted his billing the same day as the surgery, may have a different dx, because he/she did not have the path report available for review at that time.) So my physician's concern is, how crucial is it that the dx code billed by the surgeon and the facility match?

And yes, it would be better for the surgeon to wait for the pathology report to come back before submitting a claim for the service. But there are occasions where the billing needs to be submitted immediately. (end of month, end of year, etc)
 
No the DX code does not need to match the facility. The procedure code must match. With the exception of a skin lesion excision, you may code what you know at the time of coding or wait until the study results have been rendered. As long as you are not using a path diagnosis like neoplasm uncertain, then you may code the reason for the procedure as opposed to waiting for the path report.
 
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