Wiki Pathology Coding

[mandrews582000@yahoo.com]

Dear Fellow AAPC members,

I am working with a pathology firm. The compliance aadvice is, "When there is nothing on the requisition but OPEN WOUND, there is a need to contact the referring provider for detail information". I believe this is a waste of time for the S91.xxxx series of codes because I am under the impression that the Initial encounter or subsequent encounter pertains to the provider providing the service not the provider tending to the wound. We are providing Pathology services. If we bill a subsequent or sequel what will stop the payor from denying waiting on the initial?? And possibly more important, I am thinking that because we are a pathology company everything we do is diagnostic and we have the result diagnosis and that should be the primary...Am I wrong!
please advise

 

[JJOHN0312]

Re: Pathology

I think we need to be as specific as possible in our coding. The 7th character is based on whether active treatment is being provided during the current encounter. A=When the patient is receiving active treatment for a condition D=Completed active treatment and is in the healing phase, and S=All treatment and healing has been completed, however, the condition exists due to the original condition. A good place to look would be the OP reporting guidelines for ICD 10 CM which can be found on the CMS website. cms.gov Hope that helps!

Josie