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Billing off Pathology. PLEASE help!!

  1. Default Billing off Pathology. PLEASE help!!
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    One of our physicians does not think we should be billing surgeries with the diagnosis from the pathology. This was one of the first things I remember being taught in coding school. Can anyone point me to some proof that I can show the doctor. That you should be using the pathology diagnosis to bill for the surgery. For example billing for a prostate needle biopsy with the prostate cancer code that is on the pathology, instead of the Elevated PSA that they are having the biopsy done for.

    Please help!! He is VERY adamant that we should not be doing this!

  2. #2
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    the only time you are required to wait for a path report is a skin lesion excision. Otherwise you may code form the symptoms or the result after study, either is OK.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Well I know that you can do either. But I was taught in coding school, and by coders who mentored me that you should use the pathology. Not that you have to. So that is the way our company has always done it. Now we have a doctor ranting that we are changing his diagnosis code which is illegal. So I just wanted some back up documentation to show him that it can be done with pathology.

  4. Default
    There are alot of opinions/information on this subject here on forums. I suggest you go to the "Search" tab and type in pathology diagnosis...or pathology results, etc. to see what comes up. Some of us never wait for lab results to determine the ICD-9, others of us always do.

    Jenna

  5. Default
    Thanks, that's what we've been doing. But the doctor doesn't seem willing to read all of it. His issue is that if we look at the pathology and code something with cancer (because that's what the pathology says) that we are diagnosing the patient with cancer. And we aren't qualified to do that. He also states that he believes you have to bill with everything you have on the date of the surgery. So that would exclude the pathology. He isn't really the type to be reasoned with. Wish us luck

  6. Default
    I code/bill for Ortho sx's. Now we don't send very much to Pathology...just doing alot of repairs & revisions, etc...so waiting for any results in order to assign an ICD-9 is not what we do. I can understand your Physician's concern...he wants to be careful to code only what he has knowledge of at the time of service. What is the "reason" for the surgery? It's not cancer...cuz at the time of surgery no one knew whether it was cancer or not. So the "reason" for the surgery would be whatever he had knowledge of...mass, tumor, lesion, whatever prompted him to whisk patient into surgery. This certainly isn't incorrect coding, so if he is adament...rest assured you're not doing anything wrong.

    Jenna

  7. #7
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    Columbia, MO
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    Quote Originally Posted by ECS2418 View Post
    Thanks, that's what we've been doing. But the doctor doesn't seem willing to read all of it. His issue is that if we look at the pathology and code something with cancer (because that's what the pathology says) that we are diagnosing the patient with cancer. And we aren't qualified to do that. He also states that he believes you have to bill with everything you have on the date of the surgery. So that would exclude the pathology. He isn't really the type to be reasoned with. Wish us luck
    Since the pathology has been issued by a pathologist, who is a physician, then you are not diagnosing the patient....... a physician did that. You have a hard job ahead of you to try and convince someone that will not listen. You may look in the coding guidelines this is covered in there as well, but it sounds like he is not going to listen to anything.

    Debra A. Mitchell, MSPH, CPC-H

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