Compliance Corner

Can a lab add diagnosis codes to a claim in addition to those provided by the ordering physician, based on the results of the test? The answer to this depends on the tests involved and who is providing the new diagnosis information. First, for routine lab services such as routine chemistry, routine urine analysis, and routine hematology tests, the laboratory may not add diagnosis codes simply based on the results of its tests. Any diagnosis codes included on claims for these kinds of tests must come from the ordering physician. For tests that are reviewed or read under a microscope by a pathologist who then renders an interpretation or a diagnosis based on that review and issues a written report that includes an additional diagnosis beyond those provided by the ordering physician, the lab may add that diagnosis in addition to those provided by the ordering physician.