Understand Why Waiting for Pathology Matters in Coding
Question: I read the Revenue Cycle Insider article, “Use These 5 Steps to Code Colon Polyps When Pathology Is Pending,” and I have a follow-up question: why shouldn’t we assign a diagnosis code before the pathology results have returned? Kentucky Subscriber Answer: When you’re coding procedures that involve biopsies or polyp removal, you should never assume the final diagnosis before pathology is reported. The pathology result is what confirms the true nature of the lesion and determines whether the correct code falls into an “unspecified finding,” “benign neoplasm,” or another diagnostic category. If you code too early based only on endoscopic appearance, you risk assigning a diagnosis that is not supported by final clinical evidence. This can lead to claim corrections, payer denials, or post-payment recoupments once the pathology report is reviewed. Waiting for pathology ensures that your coding reflects the confirmed diagnosis rather than a clinical impression. It also allows you to properly update the encounter from an interim finding (such as a general polyp code) to a more specific, pathology-supported diagnosis when appropriate. In short, the pathology results are the deciding factor. Coding before these are finalized may be necessary for operational timing, but should always be treated as temporary until confirmed results are available. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
