Medicare Compliance & Reimbursement - 2013 Issue 11
Reader Question: Hold Your Codes Until Path Report Is In
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Article Overview
This reader Q&A addresses whether a surgeon’s claim should be submitted before pathology results are back. It is aimed at coders and billing staff who handle surgical claims and need to understand how final pathology can affect diagnosis selection, procedure coding, and reporting of related services. The article presents broad reasons for waiting, with examples drawn from outpatient diagnosis coding and surgical procedure coding.
Why This Topic Matters
Pathology findings can change the coding picture after a procedure is performed. Understanding that timing issue helps reduce avoidable denials, improve code specificity, and support accurate reporting of associated surgical services.
Article Sections
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Question
The reader asks about billing timing for surgeon claims in relation to pathology reporting.
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Answer
The response discusses general considerations for waiting on pathology results before finalizing coding and billing decisions.
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Reasons to wait for the pathology report
This section outlines the broad coding and billing implications of having final pathology information available before claim submission.
What You Will Learn
- Why pathology results can matter when finalizing surgical claims
- How final diagnosis information can affect diagnosis coding
- How pathology findings may influence procedure code selection
- How additional reported surgical services may depend on supporting documentation
Who Should Read This
- Medical coders
- Billing staff
- Surgical practice managers
- Physician office staff
Codes Discussed
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