Wiki Lab with R30.0 but comes back + for UTI and encounter has N39.0

[AnnieP]

Our providers are doing the urine dip order with a symptom such as R30.0. When the dip comes back positive and the provider states UTI in the encounter, do we use N39.0 for the encounter and change the lab to match, or add the symptom diagnosis to the claim along with N39.0 in order to cover the ordered lab? Technically, the symptom should not be listed if the patient has a UTI and N39.0 is used, but then we really shouldn't be changing the labs ordered by the providers.

I did find something from 2014 that states we should use the symptoms only as the results would not be completed at the time of visit, but from what I can see in our recs, it looks like the result may be back that soon.

Help!

Anne

 

[thomas7331]

If the lab and provider are both part of the same organization and you are coding for the lab and provider services as a single encounter on the same claim then you would use the diagnosis made by the provider for that encounter, in this case N39.0 - you would not use the symptom code since a definitive diagnosis has been made for that encounter for that symptom. But if the lab is a separate entity and submits its claims independently, the lab would use the diagnosis code given by the provider on the order, R30.0. The lab is not required to wait for the provider's interpretation to bill for its services, and is not required to go back and change the diagnosis after the fact once the provider has interpreted the lab results.