decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 11 (November)
Hematuria visits with U/A: Code what you know at the end of the visit; don't wait for pathology
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Article Overview
This article discusses coding workflow for hematuria encounters when urinalysis or cytology is sent to pathology and final findings are not immediately available. It is aimed at coders, urology practices, and billing staff who need to understand how available information at the end of the visit affects diagnosis selection, claim timing, and which provider reports the diagnosis. The discussion references Medicare guidance and broad categories of symptom, suspected-condition, and test-result coding.
Why This Topic Matters
It helps readers understand how to handle diagnosis reporting when test interpretation is delayed, which affects claim submission and coordination between the referring clinician and the interpreting provider.
Article Sections
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Hematuria visits with U/A
Introduces the topic of hematuria encounters and the role of urine testing sent to pathology. Sets up the discussion of coding based on information available at the time of the visit.
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Medicare guidance on coding with pending test results
Summarizes Medicare manual language about reporting based on available information when physician interpretation is delayed. Focuses on general billing timing and responsibility for coding.
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When a diagnosis is confirmed later
Describes the distinction between coding an encounter before final interpretation and coding after a diagnosis is established. Notes the role of the interpreting provider and later follow-up procedures.
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Office visit and follow-up examples
Provides a practical billing scenario involving an initial visit, later test findings, and possible subsequent procedures. Also mentions alternative handling when no other diagnosis is available.
What You Will Learn
- How delayed pathology results affect diagnosis reporting at the time of a visit
- How Medicare guidance addresses coding when test interpretation is not yet available
- How coding responsibility can differ between the referring clinician and the interpreting provider
- How initial and follow-up encounters may be handled in a hematuria workup
Who Should Read This
- Medical coders
- Urology billing staff
- Physician office staff
- Pathology billing staff
- Compliance staff
Codes Discussed
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