Wiki Preparing for ICD-10 in pathology

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I am the lone coder in my pathology office with just 2 years of experience and have been charged with ICD-10 transition for our office. I would be interested in sharing questions and ideas with others of you who work in pathology offices.

I have completed AAPC online ICD-10 training. I am in the process of creating a list of crosswalks for our 50 most commonly used codes and then plan to do an audit of 1) the information we receive from our clients on requisitions and 2) our pathologists' diagnoses - for both, looking to see what work needs to be done to be able to code to the highest specificity in ICD-10.

From my own observations, I think our biggest issue will be getting more specific information from our clients. I'm wondering if your offices have given this consideration and if you have made any plans yet to address that.

What are you all doing to prepare for the transition.
 
pathology consults

Can anyone tell me how the following scenario should be coded-

A frozen slide is sent to our lab for a pathologist to consult on. Our lab makes their own blocks and does IMC stains.

The issue is that it isn't a straight forward consult because our lab is creating their own blocks. If the doctor had sent us blocks, the consult would be coded as 88323. I don't see how we can bill 88305 along with 88342 for any antibody stain because the other provider would have billed the 88305. Any suggestions? It seems that we're better off billing globally for the consult code 88323 although we've done additional work. Thanks.
 
I agree. I would go with 88323 and put a 59 modifier on any special stains that get done.
 
icd-10 transition

Hi. I read your post about preparing for the transition to 10 and creating crosswalks. I also will be spearheading the same endeavor for my group. I feel the biggest problem will come from the diagnostic information we get from our clients. As far as the developing an internal crosswalk for our pathologists, you can find the generic 10 code for current 9 codes. The problem of course is that 10 requires more specificity. It sounds like you are doing pretty much what I plan on doing and that is auditing charts and recoding them in 10. It will be useful to have examples on hand to educate the doctors in 10. Do your pathologists assign their own codes? I will be attending an AAPC 10 seminar toward the end of March to learn about 10. After the seminar, I'll be delving into it in preparation of educating staff and possibly client offices. Keep me posted on problems you find and I'll do the same. Thanks for your post!
 
Hi! Thanks for your response. My employer purchased this book for me which has been VERY helpful in creating the crosswalks: https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod1250083&navAction=push I am using this resource to create an Excel sheet that shows how the codes we use now will map to or expand in ICD-10.

My employer also purchased this webinar:http://www.mgma.com/store/education...-and-icd-10-cm-for-pathologists-audio-edition
When we have watched it, I will report back on it's usefulness.

My pathologists do not assign their own ICD-9 codes. I do that along with the CPT codes. Do your pathologists assign codes?

I also think our biggest issue will be getting the details we need from our clients. I have raised that possibility and discussed that we might need to change our requisitions. We currently do not ask our clients to provide their pre-procedure diagnosis codes (although some that are using EHR already do). We only ask for "clinical information" and "specimen sites." It's not uncommon for "clinical information" to be blank or inadequate. How do you get that information from your clients?
 
Most of our clients are providing us with codes. I'm hoping they are all getting geared up for 10 and that their EHR software will require it.

Thanks for the AMA 10 Crosswalk resource. Do you find that it is worthwhile? Is this Crosswalk particularly helpful with pathology? I did see that 10 audio seminar done by Padgett on the MGMA website. Disappointed to hear that it is pretty basic.

I've been reading lots of pathology threads. I have a lot to learn about what a test is about or the work done for a code, etc. When you started in pathology, did you read Padgett's handbook and did you feel it gave you a solid understanding to pathology coding and billing intricacies? Thanks for you response and suggestions.
 
The AMA mapping book has been VERY helpful. Our practice is heavy on derm but crosses many specialties.

Thanks for the info about your clients sending you the codes. It helps to know that is a precedent elsewhere and would not be an unreasonable request to our clients.

The Padget resource has been very helpful as well. It is very detailed and sometimes challenging to slog through all the details, but there doesn't seem to be any other resource as useful.
 
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