AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Quarter 1; In This Issue
Outpatient Laboratory, Pathology and Radiology Coding
A patient undergoes outpatient surgery. A skin lesion of the cheek is surgically removed and submitted to the pathologist for analysis. The surgeon writes on the pathology order, “skin lesion.” The pathology report comes back with the diagnosis of “basal cell carcinoma.” A laboratory-billing consultant is recommending that the ordering physician’s diagnosis be reported instead of the final diagnosis obtained by the pathologist. Also, an insurance carrier is also suggesting this case be coded to “skin lesion” since the surgeon did not know the nature of the lesion at the time the tissue was sent to pathology. Which code should the pathologist use to report his claim? ...
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Article Overview
This Find-A-Code article reviews outpatient laboratory, pathology, and radiology coding guidance and addresses common questions about coding practice in hospital-based and stand-alone settings. It is aimed at coding professionals and staff who perform coding functions, and it summarizes published advisory material and question-and-answer style clarification. The article focuses on general outpatient coding considerations, including how diagnostic information is handled in pathology-related claims and how prior advice is applied in the outpatient context.
Why This Topic Matters
Outpatient diagnostic services are frequently coded by teams that must align ordering information, test findings, and facility reporting requirements. This article helps readers understand the scope of published guidance that may affect coding consistency across laboratory, pathology, and radiology encounters.
What You Will Learn
- The scope of outpatient laboratory, pathology, and radiology coding guidance
- How published Coding Clinic advice is discussed in the outpatient setting
- The roles of ordering information and pathology findings in outpatient claim coding
- How the article frames guidance for coding professionals and billing staff
Who Should Read This
- Medical coders
- Coding auditors
- Pathology billing staff
- Hospital outpatient coding staff
- Standalone facility coding staff
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