Wiki third party diagnostic lab question


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This may be an easy question but I am going to start working at a third party lab and want to make sure about coding correctly. As a coder/biller can you code from the results alone, or must you code based on what the chart notes/ICD-10 code used that are provided by the clinic on the req's? Or can you do both based on any results?

thank you!
You can only code a diagnosis from results that are documented by a physician or qualified NPP, e.g. from a pathology report dictated by the MD. If it is a clinical lab test with automated results, you cannot use results to come up with a diagnosis - for those types of tests you would need to use the diagnosis submitted by the provider on the order.
Thank you! So we are sent samples and run the sample based on what the dr has ordered. From there we must legally only bill whats on the req that was ordered or can we adjust based on the results? Or if we get the chart notes can we do other DX coding to get more specific for the claim to pay?
Most labs will follow a process of contacting the ordering physician for a more appropriate diagnosis if the code provided with the order does not meet payer requirements for reimbursement. Here's a helpful, although somewhat outdated resource from CMS:

See section 10.1, 'ICD-9-CM Coding for Diagnostic Tests' which outlines a good process for determining the correct code. Although this section of the Medicare manual was retired when ICD-10 went into effect, most labs and hospital facilities that I know of still follow a process like this. The lab you're working for really should have an internal policy vetted by their compliance people to guide you on how they want this done.
That's a great article. Thank you. We are a newer lab and considered a reference lab, so just trying to get more detailed information and making sure others are doing the same...some things seem a little off. I thought we could only test and bill what was on the req, but another coder is saying you can code based on the results.