Wiki Hospital coder overriding pathologist diagnosis


Fairfield, CA
Best answers
Our hospital based pathologists are having their diagnoses overridden by the hospital's coder for billing the TC component. She has indicated that the diagnosis must match the surgeon's operative report per coding guidelines or the hospital will be in non compliance. She has multiple coding certifications. The hospital is in a small community and there is a communication barrier due to cultural differences. It is my belief that the pathologist's findings are final. She has stated that if the pathologist bills with a different dx than the hospital, the hospital will not get paid. She states there is documentation regarding this. Does anyone know if there is documentation to support her statement and where I might find it?
This is completely untrue! The hospital will use the indication for the surgery as the surgery diagnosis, the pathology coder needs to code the diagnosis as rendered by the pathologist. It not the coders prerogative to change a diagnosis ever There is no directive that states this is to be done or correct. it will not affect the hospitals reimbursement for the codes to be different.