Electrophoresis

Malevolus

New
Messages
2
Location
Molalla, OR
Best answers
0
I recently started coding several lab tests - 88334, 88335, 84165, 84166.
Often on the results report there is no diagnosable condition or clinical history listed. I get things like:
"Weak IGG band present in the gamma zone, too weak for electrophoresis"
"No monoclonal immunoglobulins identified by serum immunofixation"
"IGG Kappa band present in the gamma zone in low concentration"
"Homogeneous band (M Spike) present in the gamma zone. Concentration = 0.35g/dl This may be an overestimation due to migration with normal serum proteins. Identified by immunofixation as IGG Kappa"

Now I know I may just be drawing too much on my surgical pathology background and overthinking and being over cautious , or that I'm just not familiar enough with these reports yet. I've talked to another coder and my manager and they suggested looking at abnormal findings codes. Since there is no specific documentation stating abnormal findings, atypical cells, elevated levels, etc, I am uncomfortable coding these as such since I can't confidently back up my coding decisions. I'm looking at it kind of like an intestinal resection for "adenocarcinoma present at 20cm from cecum" This obviously would be the ascending colon, but since it isn't documented as such, and we don't know if the patient has had prior intestinal resections, it would be coded to malignant neoplasm of colon, unspecified site.

I also do not currently have access to the patient's chart. Normally I'd reference the associated visit/Op report/etc and pull a diagnosis from there as to why the test was performed. Would any of you feel confident coding an abnormal finding based off of the interpretations listed above?

Others have interpretations like:
Hypogammaglobulinemia
Homogeneous band (M Spike) present in the gamma zone. Concentration = 0.07g/dl This may be an overestimation due to migration with normal serum proteins. Identified by immunofixation as IGG Kappa

This is pretty straight forward and the Hypogammaglobulinemia is coded. But if you take that away and only have the second part, it goes back to unable to code. I was always lead to believe that you cannot code off of lab results or interpret interpretations. You need a specific diagnosis/condition/notation of what those lab results mean.

I hope I've made sense, I've gone kind of cross-eyed with the amount of reports I've gone through so far today and have been unable to code.
 

Malevolus

New
Messages
2
Location
Molalla, OR
Best answers
0
A better example came to mind.

Say you have an esophageal biopsy specimen and in the FInal Pathological Diagnosis it says 35 eosinophils present per hpf.

While technically this does meet the typical threshold for EoE, because documentation does not state EoE and it is a lab result, it isn't codeable. In this case, I'd first reference clinical history, and if there isn't any, I'd reference the visit/op/associated report for the service. In this case, assume no other information is available, and the provider cannot be queried, I personally would not be able to code this service without some kind of additional information.
 
Top