Wiki Billing for Pathology and Labs HELP...

[IronLobo]

Example: New PT comes in to practice with chest pain. Problem list is clean, due to PT being new to the practice.
Dr. orders a series of blood tests, but has no diagnosis that meet medical necessity.
Can the Dr. wait for Lab results to come in, to then assign a diagnosis that does meet medical necessity for LABs ordered?

To my understanding, only ERs can wait for results to blood work before billing. Not outpatient practices.

 

[CodingKing]

I thought anyone can hold their claim pending the lab/path report. I'm surprised its not a requirement. I can see in the future insurance companies refusing to accept unspecified DX codes.

 

[IronLobo]

I thought anyone can hold their claim pending the lab/path report. I'm not surprised its not a requirement. I can see in the future insurance companies refusing to accept unspecified DX codes.

See, I thought so too. But just recently I was told that that is not the case.
You have to have a sign or symptom diagnosis, that meets medical necessity for the LABs ordered.
And that there is no such thing as "Rule Out" diagnosis.

 

[CodingKing]

Ordering of labs may be different but as an example for removal of skin Lesions, code selection is based on type of lesion. For excisions Malignant and benign have different CPT with different reimbursement amounts so not only do you need Path report to properly code the DX you need it for the CPT as well.