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Sandeep Posted Fri 02nd of February, 2018 04:51:43 AM
The Pathology record we receive mentions following under findings: 1) Non diagnostic - Request for repeat sample 2) Sample disintergrated during processing. In above scenarios can we bill to the insurance for the test? How to code in these scenarios and which CPTs and ICDs will apply?
SuperCoder Answered Tue 06th of February, 2018 00:38:38 AM

Hi Sandeep,

There are few things that needs to be kept in mind while billing for non-diagnostic request for repeat sample and disintegrated sample during processing:

1 If the pathologist receives insufficient or inadequate specimen but performs his work, even if specimen is non-diagnostic, he can still pay for his services, however, his documentation must include accession (laboratory formally receiving specimen for labelling and ready to send for laboratory medicine for testing), examination and report. Also, If the pathology report documents the pathologist's gross and microscopic findings, you can charge for the service even if the findings don't provide a definitive diagnosis. (select from code range 88300-88309).

2: On the other hand, if the pathologist simply states that the submitted specimen is "inadequate for evaluation," then you cannot charge for the service. 

Please find below link for your reference and further clarity:

Feel free to ask for any further query. Thank you.

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