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General Surgery Coding Alert

Reader Question:
3 Reasons to Wait for Dx

Question: Is there a hard-and-fast billing rule that requires us to wait for the pathology report to send out our general surgeon's claims?Minnesota SubscriberAnswer: While there is no hard-and-fast rule that requires you to wait for the pathology report before billing the surgeon's work, doing so is to your advantage. Read on to see three good reasons why you should wait for the path report:1. Because ICD-9 outpatient coding guidelines state that you should not code a "rule-out" diagnosis, you'll be left coding signs and symptoms if you don't wait for the path report. For instance, if your surgeon performs a breast biopsy, you'll need to report something like 611.72 (Lump or mass in the breast) instead of a specific code such as 174.x (Malignant neoplasm of female breast).2. The final diagnosis might impact your procedure code. For instance, you'll choose different procedure codes for benign versus malignant lesion removal [...]