Pathology/Lab Coding Alert

New codes show medical necessity, pathologist's diagnosis

From herpesvirus lab tests to non-Hodgkin's lymphoma diagnoses, you-ll need to know the fall ICD-9 code lineup if you want to get paid for your work.

Get ready now to avoid deleted codes and start using new codes to show medical necessity for lab tests. Pathologists need to prepare for changes too, so they can report the most accurate cancer diagnoses based on specimen exams. ICD-9 Codes Show Medical Necessity Even though your lab doesn't assign the diagnosis code for ordered tests, you must be familiar with how these codes show medical necessity.

According to Lori Hendrix, CPC, CPC-H, coding consultant with Coding Strategies Inc. in Powder Springs, Ga., the ordering physician must supply the diagnostic information that shows the reason for the test. And the physician's diagnosis should support that the test is -reasonable and necessary- to meet the patient's medical need.

For many lab tests, Medicare provides a National Coverage Determination (NCD) that specifies which ICD-9 codes support medical necessity. Medicare updates NCDs quarterly, incorporating ICD-9 code changes in the -covered diagnoses- lists. You-ll need to keep up with these changes to know when your lab should secure a signed advance beneficiary notification (ABN) if a physician orders a test without a payable diagnosis. Pathologists Assign Final Diagnosis Unlike clinical lab tests that you report with the ordering physician's diagnosis, you-ll often report a pathology exam using a definitive diagnosis that your pathologist makes.

ICD-9 coding instructions state that if a physician makes a confirmed diagnosis based on the results of the diagnostic test, you should report the confirmed diagnosis, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. That means you need to be abreast of current ICD-9 coding for neoplasms and other conditions your pathologist might diagnose.

For example: Your pathologist receives a surgical specimen identified as a -mole from the right forearm.- The pathologist personally reviews the specimen slides and makes a diagnosis of -malignant melanoma.- The pathologist should report 172.6 (Malignant melanoma of skin; upper limb, including shoulder) as the primary diagnosis, Miller says.
 
Get Ready for October Changes Beginning this fall, many of the nearly 170 new and revised ICD-9 codes will impact coding for labs and pathologists. Get familiar with the following code changes so you-ll be ready to use them when the time comes. Remember, you no longer have a grace period for using these codes--you must implement them on Oct. 1 to get
paid for your services.

Lymphoma changes: ICD-9 overhauls non-Hodgkin's lymphoma coding by adding the following new codes:

- 200.4x--Mantle cell lymphoma

- 200.5x--Primary central nervous system lymphoma

- 200.6x--Anaplastic large cell lymphoma

- 200.7x--Large cell lymphoma

- 202.7x--Peripheral T cell lymphoma. [...]