COVID-19 lab billing (positive & two negative)

ksobota

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Wondering how to report this. We have a patient we did testing on

Monday rapid test: positive
Tuesday rapid test: negative (it was done in error. nurse misunderstood that doc wanted the PCR swab, so we aren't billing this one, but it was done)
Tuesday PCR test: negative

So, do we still diagnose this patient as positive? Do I just report the result as it was? Doctor is stating patient is negative, but with a positive result, just curious as to what to report to insurance.

Our physician is not treating him as a covid illness. Patient had close exposed to a grandchild that was positive and symptoms of an illness. Should I just use the exposure and symptoms?
 

thomas7331

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You should go with what the doctor has stated. Unless your organization has given you specific guidelines or instruction to code positive test results as a COVID-19 diagnosis, then you should always assign diagnosis codes based on the physician's documented statement or interpretation, not the lab results.
 
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ksobota

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87426
Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])
 

ksobota

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You should go with what the doctor has stated. Unless your organization has given you specific guidelines or instruction to code positive test results as a COVID-19 diagnosis, then you should always assign diagnosis codes based on the physician's documented statement or interpretation, not the lab results.
"Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID19 test result"

This is from guidelines from the new book for 2021 and I had remembered this thread and wanted to let you know what I had found in the book.
 

thomas7331

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"Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider or documentation of a positive COVID19 test result"

This is from guidelines from the new book for 2021 and I had remembered this thread and wanted to let you know what I had found in the book.
I would agree with coding a confirmed diagnosis if the positive test result is from the same encounter (in other words, in the example you give above if the positive result on Monday was part of the same hospital stay in which the provider saw the patient). However, if your positive result on Monday was at a different encounter, and now your provider is documenting that the patient is negative, then I would not code a COVID-19 diagnosis because that positive result is part of the history that the provider is reviewing and is not a current diagnosis that you can assign for that encounter. It's generally not acceptable to bring a diagnosis from a prior encounter for coding purposes without first querying the provider for documentation that the condition is still present at the current encounter.
 
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