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Path Reports

Amber Posted Tue 25th of November, 2014 09:45:19 AM

We are having a discussion in our office about path reports. Do we need to hold out our EGD and Colonoscopies until we receive the path reports before billing? Some say we just bill them with the preliminary diagnosis given others say we must wait on results of path to give final diagnosis. Is there a difference from professional billing and outpatient surgery center facility billing?

SuperCoder Answered Wed 26th of November, 2014 09:05:38 AM

Thanks for your question. It is always best to code to the highest degree of specificity. According to coding guidelines,in the outpatient setting you can code for signs and symptoms if there is no definitive diagnosis by the end of the visit. If it is possible, you can hold your claims until pathology results are reported and you have a definitive diagnosis. If your physician includes a key word like mass or some other term that may describe a serious condition in the procedure notes, you should definitely hold those claims until the pathology report returns. It the outpatient setting is not wrong to submit your claims before pathology results come in. Hope this helps.

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