nlaaron
Networker
For outpt facility clinic visits, can I code results from the urine culture? The dr saw the pt for dysuria, diagnosed uti and ordered culture, but he did not comment on the results..... The results showed E Coli.
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Wiki coding from urine culture ?
mitchellde
True Blue
No a coder may not code from a lab result. A lab report has had no physician interpretation it is merely a reported result. The physician must interpret the result and determine if there is any significance. A coder does not know the difference between a specimen that has been contaminated vs one that has the significance of an organism present in the body.
We would just bill for the dysuria because the uti code is unspecified and we are not supposed to use unspecified codes unless we absolutely have to.