dx vs path

[KDCOWGIRL]

Lately I've had a couple of instances where a dr has dictated a dx that is then contradicted by the pathology report. My understanding is that I should be using the pathology report as the dx that goes on the bill. Is this correct? (I am coding for an ASC.)

 

[dja214]

You should not code a disease process without a confirmed diagnosis. You need to wait until the pathology report comes back so you have confirmation that the disease actually exists.

Hope that helps!
Deanna

 

[KellyLR]

Agree

I agree. When you have your hands or eyes on the Pathology report and the report confirms the disease, approach the physician and ask why they went with something else.

 

[dja214]

Also remember not to code "rule out" and/or "probable" diagnosis for out patient.

If your physician does not want to wait for the pathology to return, then you are forced to code the signs and symptoms. Using those codes may run into a problem with the LCD/NCD's for that particular procedure code you are billing.

Good luck!
Deanna

 

[KDCOWGIRL]

Thanks for all your replies. My problem is the surgeon won't change his dictation even though it conflicts with the path report. I coded per the path report and didn't get paid since it doesn't match what the surgeon billed with. The difference is between a benign and malignant excision so it affects both the procedure code and the dx code.

 

[ajs]

Thanks for all your replies. My problem is the surgeon won't change his dictation even though it conflicts with the path report. I coded per the path report and didn't get paid since it doesn't match what the surgeon billed with. The difference is between a benign and malignant excision so it affects both the procedure code and the dx code.

The surgeon can add an addendum to the orginal note stating the results of the path report. This is much more accurate reporting anyway. Too bad since it affects how the patient's condition is reported to insurance and can affect reimbursement too.