Urology BX question

tmsmith

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I have a question on the BX code 55700, the hospital billed this code with dx code 185 malignant neoplasm of prostate, which is what the path report came back as, but our doctor billed this as elevated prostate 790.93. The patient is upset because they paid the physician in full, but there is a balance at the hospital because of the 185 code. I think the doctor should have billed with the 185 too since that is what the path report came back as. For this code, is it better to wait for the path report before you bill, or are the symptoms acceptable.
When I code any biopsy, I always wait for the path report. What are some of the practices out there of other coders?
 

mitchellde

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The only time you are required to wait for the path report is for skin lesion excisions. For everything else you may code what is known at the time of coding or after study.
 

tmsmith

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Debra,

the patient is upset that the main dx the hospital used was 185, is the hospital required to wait for the path report before they bill or is that just a standard practice, do you know?
 

mitchellde

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The rules are the same for them they are allowed to wait if they want. In the facility I worked in we had an internal policy that we were required to wait for all path reports before coding, so they may have a similar policy. I fail to see why it makes a difference though as far as payment, the payer should pay the bx either way, it is possible the patient has a deductible they have to pay. I am not understanding the problem, the facility is correct and you are correct. What is the problem?
 

tmsmith

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I don't think there is a problem, I think that the patient has a deductible and is upset because they have a balance. The billing manager wanted a second opinion and I said I would see what I could find. You just confirmed what I said, and I spoke to a friend that does inpt coding and she said it is their policy to wait for the report and confirm with the doctor. Thank you so much:)
 
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