I would like to learn more about lab coding. I have looked from webinars/ workshops and have not found many. Looking for any and all suggestions. I will add I did purchase coding essentials for lab 2023 book.
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Wiki Laboratory Coding
- Thread starter hdavis89.hd@gmail.com
- Start date
TThivierge
True Blue
Hi HDavis
At my job I code a little bit of everything, but I can give you some lab coding tips. When I code lab the physician (outpatient or clinic setting)should give reason why billing or use dx list of codes for the current patient 's day s treatment. The provider is the expert and should share this data or give it to the assigned nurse to fill out lab request. The lab codes can come in panels thus only bill 1 CPT panel code instead of all lab test done in panel. Some example of panel lab codes are : 80047 80050 80048 80053 80055 80074 check CPT manual yr 2023 pages 596-597 for list of individual labs under each panels. If your provider gives you no specific reason why do lab test(but he should as follow policy of compliance) you can bill dx Z01.89. Once read lab results it may say positive or negative...we are required to review lab results once pathologist has given report to ensure select right code. I have seen positive Substance abuse dx .....thus use the dx code related to positive results put on claim. One of CPT we use is CPT 82565 or 82043 is used a lot of checking sub abuse with linking dx F10 F12, F19 as examples if positive urine or blood. I always use Z13.39 or Z02.83 dx last to add what checking for sub abuses in this related scenario. Also check out dx R78.89.
* For STD use lab codes 87491, 86631, 87590,87591 ,86593 ds HIV- 86701, 86703. Corresponding dx codes if positive results can be Z11.3 A56, A63.8, A64 or dx Z11.51 or block dx R86 -R85
*Modifiers can use is 91 if repeated during same day differ times, and modifier 90 sent to differ lab and QW if lab claims billed to Medicaid
*If pt suffers with ongoing dx E11 DM usually get lab CPT 82962 every 90 days or checking to see if pt has DM
*If pt gets a fecal lab test CPT 82270 usually linked with dx Z12.11-Z12.12 or Z13 .811 or any digestive symptoms K59, R19,Etc suffers with. Lab CPT 83880 occult blood fecal test .
*Unlisted lab codes usually not used but payers may not comp for them and not go thru edit system. If used usually payer wants a report.
* All types of lab test for specimens, biopsy, blood, urine, immunology ,smears, or check disease in which most providers know the list of CPT lab codes to use in their specialty. As example colon biopsy taken when review lab results use the area of colon when specimen removed & biopsy see dx block D12 if benign. Lab used for colon bx. is sometimes CPT 88305 or 88304. If lab results come back with malignant areas of colon use dx block of C17 to C21.
*Common urine tests CPT 81001-81003 possible dx codes I10 and N39.8 Pregnancy urine 81025. There is prego test for blood too.
*Sometimes provider check coagulation (prothrombin ) in blood use dx R79.1 or D68.89 or cardiac code for lab test or checking for influence from meds dx Z79.89 with CPT 85610 or 85730.
*Other time providers will check vitamin deficient using lab code such as CPT 82607, 82603, 82746 Folic acid, CPT 82728Ferritin (aka iron) linking with dx E55.9, E53,8, D52.8, and dx E61.1. These lab test names orders can be indicators what provider seeking.
Thus you will probably read documentation of reason why pt seeking treatment which is the rationale on why provider ordering labs to locate corresponding dx code. I hope these tips help you somewhat.
Lady T
At my job I code a little bit of everything, but I can give you some lab coding tips. When I code lab the physician (outpatient or clinic setting)should give reason why billing or use dx list of codes for the current patient 's day s treatment. The provider is the expert and should share this data or give it to the assigned nurse to fill out lab request. The lab codes can come in panels thus only bill 1 CPT panel code instead of all lab test done in panel. Some example of panel lab codes are : 80047 80050 80048 80053 80055 80074 check CPT manual yr 2023 pages 596-597 for list of individual labs under each panels. If your provider gives you no specific reason why do lab test(but he should as follow policy of compliance) you can bill dx Z01.89. Once read lab results it may say positive or negative...we are required to review lab results once pathologist has given report to ensure select right code. I have seen positive Substance abuse dx .....thus use the dx code related to positive results put on claim. One of CPT we use is CPT 82565 or 82043 is used a lot of checking sub abuse with linking dx F10 F12, F19 as examples if positive urine or blood. I always use Z13.39 or Z02.83 dx last to add what checking for sub abuses in this related scenario. Also check out dx R78.89.
* For STD use lab codes 87491, 86631, 87590,87591 ,86593 ds HIV- 86701, 86703. Corresponding dx codes if positive results can be Z11.3 A56, A63.8, A64 or dx Z11.51 or block dx R86 -R85
*Modifiers can use is 91 if repeated during same day differ times, and modifier 90 sent to differ lab and QW if lab claims billed to Medicaid
*If pt suffers with ongoing dx E11 DM usually get lab CPT 82962 every 90 days or checking to see if pt has DM
*If pt gets a fecal lab test CPT 82270 usually linked with dx Z12.11-Z12.12 or Z13 .811 or any digestive symptoms K59, R19,Etc suffers with. Lab CPT 83880 occult blood fecal test .
*Unlisted lab codes usually not used but payers may not comp for them and not go thru edit system. If used usually payer wants a report.
* All types of lab test for specimens, biopsy, blood, urine, immunology ,smears, or check disease in which most providers know the list of CPT lab codes to use in their specialty. As example colon biopsy taken when review lab results use the area of colon when specimen removed & biopsy see dx block D12 if benign. Lab used for colon bx. is sometimes CPT 88305 or 88304. If lab results come back with malignant areas of colon use dx block of C17 to C21.
*Common urine tests CPT 81001-81003 possible dx codes I10 and N39.8 Pregnancy urine 81025. There is prego test for blood too.
*Sometimes provider check coagulation (prothrombin ) in blood use dx R79.1 or D68.89 or cardiac code for lab test or checking for influence from meds dx Z79.89 with CPT 85610 or 85730.
*Other time providers will check vitamin deficient using lab code such as CPT 82607, 82603, 82746 Folic acid, CPT 82728Ferritin (aka iron) linking with dx E55.9, E53,8, D52.8, and dx E61.1. These lab test names orders can be indicators what provider seeking.
Thus you will probably read documentation of reason why pt seeking treatment which is the rationale on why provider ordering labs to locate corresponding dx code. I hope these tips help you somewhat.
Lady T
Thank you! Do you have any tips for 85027 with modifier 59 vs. 91?
CarCC23
Contributor
i have a question if do STD lab testing and we file claim with signs and symptoms would that be sufficient or cotact exposure Z20.- codes if no symptoms. Even the results come back are we supposed to change the code to whatever the result is? My understanding is that we are not doc so we cannot diagnose or assume.Hi HDavis
At my job I code a little bit of everything, but I can give you some lab coding tips. When I code lab the physician (outpatient or clinic setting)should give reason why billing or use dx list of codes for the current patient 's day s treatment. The provider is the expert and should share this data or give it to the assigned nurse to fill out lab request. The lab codes can come in panels thus only bill 1 CPT panel code instead of all lab test done in panel. Some example of panel lab codes are : 80047 80050 80048 80053 80055 80074 check CPT manual yr 2023 pages 596-597 for list of individual labs under each panels. If your provider gives you no specific reason why do lab test(but he should as follow policy of compliance) you can bill dx Z01.89. Once read lab results it may say positive or negative...we are required to review lab results once pathologist has given report to ensure select right code. I have seen positive Substance abuse dx .....thus use the dx code related to positive results put on claim. One of CPT we use is CPT 82565 or 82043 is used a lot of checking sub abuse with linking dx F10 F12, F19 as examples if positive urine or blood. I always use Z13.39 or Z02.83 dx last to add what checking for sub abuses in this related scenario. Also check out dx R78.89.
* For STD use lab codes 87491, 86631, 87590,87591 ,86593 ds HIV- 86701, 86703. Corresponding dx codes if positive results can be Z11.3 A56, A63.8, A64 or dx Z11.51 or block dx R86 -R85
*Modifiers can use is 91 if repeated during same day differ times, and modifier 90 sent to differ lab and QW if lab claims billed to Medicaid
*If pt suffers with ongoing dx E11 DM usually get lab CPT 82962 every 90 days or checking to see if pt has DM
*If pt gets a fecal lab test CPT 82270 usually linked with dx Z12.11-Z12.12 or Z13 .811 or any digestive symptoms K59, R19,Etc suffers with. Lab CPT 83880 occult blood fecal test .
*Unlisted lab codes usually not used but payers may not comp for them and not go thru edit system. If used usually payer wants a report.
* All types of lab test for specimens, biopsy, blood, urine, immunology ,smears, or check disease in which most providers know the list of CPT lab codes to use in their specialty. As example colon biopsy taken when review lab results use the area of colon when specimen removed & biopsy see dx block D12 if benign. Lab used for colon bx. is sometimes CPT 88305 or 88304. If lab results come back with malignant areas of colon use dx block of C17 to C21.
*Common urine tests CPT 81001-81003 possible dx codes I10 and N39.8 Pregnancy urine 81025. There is prego test for blood too.
*Sometimes provider check coagulation (prothrombin ) in blood use dx R79.1 or D68.89 or cardiac code for lab test or checking for influence from meds dx Z79.89 with CPT 85610 or 85730.
*Other time providers will check vitamin deficient using lab code such as CPT 82607, 82603, 82746 Folic acid, CPT 82728Ferritin (aka iron) linking with dx E55.9, E53,8, D52.8, and dx E61.1. These lab test names orders can be indicators what provider seeking.
Thus you will probably read documentation of reason why pt seeking treatment which is the rationale on why provider ordering labs to locate corresponding dx code. I hope these tips help you somewhat.
Lady T
TThivierge
True Blue
Hi Car
If provider has documented the signs and symptoms(IE itching or urinary irration or rash) and assessment it would be ok to use for lab claim because searching for STD. But normally you code lab once the results are back. The physician or provider should give you a list of dx codes to reflect why ordering lab test for treatment for this day. Provider should have orders marked off as medical necessity when he or she is doing lab testing for STD. No you are right you cannot assume it should be documented Encounter dx for STD can be dx Z11.3, Z11.4 ,Z11.1 or Z11.8
Well hope shared a bit more data to help you
Lady T
If provider has documented the signs and symptoms(IE itching or urinary irration or rash) and assessment it would be ok to use for lab claim because searching for STD. But normally you code lab once the results are back. The physician or provider should give you a list of dx codes to reflect why ordering lab test for treatment for this day. Provider should have orders marked off as medical necessity when he or she is doing lab testing for STD. No you are right you cannot assume it should be documented Encounter dx for STD can be dx Z11.3, Z11.4 ,Z11.1 or Z11.8
Well hope shared a bit more data to help you
Lady T