Waiting for pathology

debrowne

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I need some help. I work in an OB/GYN office which performs colposcopies and LEEPs. Our auditors recently informed us that we have to hold charges on these procedures until we have received the pathology report. We have been using the pap smear results as the dx for the colpo when it is done, and the results of the pathology as the reason for the follow up visit. Can someone tell me the logic behind waiting for path? I can understand this in the hospital setting, but not in an office setting. Thanks for any help.
 

jgf-CPC

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As in dermatology you also need to wait on a definitive Dx from the pathology to bill the surgery or removal. Not what you would have seen in the visit or as in the result from the papsmear.
 

m.j.kummer

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Best practice is to wait for pathology.

Here is the link for the coding guidelines http://www.cdc.gov/nchs/data/icd9/icdguide10.pdf
which state "Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider."
and
"For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses.
Please note: This differs from the coding practice in the hospital inpatient setting regarding abnormal findings on test results."
Most of the time the pathology report is ready by the time the physicians report is ready. I would still wait for pathology if it is not ready.
 
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