Order Forms Guide - Specifying diagnosis codes at the lab test level

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Overview

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What are test-level diagnosis codes for labs?

You can now assign specific diagnosis codes to individual lab tests in a lab order to improve documentation accuracy and ensure precise coding.

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What are the differences between test-level diagnosis codes and order-level diagnosis codes?

The table below highlights the differences between test-level diagnosis codes and order-level diagnosis codes. Both test-level and order-level diagnosis codes are optional, as long as each test has a diagnosis code assigned at either level.

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Workflow Instructions

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Selecting test-level diagnosis codes in lab orders

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Selecting order-level diagnosis codes in lab orders

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Assigning diagnosis codes to order sets

Both test-level diagnosis codes and order-level diagnosis can be saved to lab order sets. Follow the instructions inthis help center articleand assign diagnosis codes as needed.

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Frequently Asked Questions

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Do I need to add a test-level diagnosis code to every test in the lab order?

No, adding a test-level diagnosis code to every test in the lab order is not required. Tests without a test-level diagnosis code will automatically be linked to the order-level diagnosis codes.

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Do I need to add order-level diagnosis codes to a lab order if it already has test-level diagnosis codes?

No, order-level diagnosis codes are not required if each test has an associated test-level diagnosis code. However, if any test lacks a test-level diagnosis code, you must either assign a test-level diagnosis code to that test or add an order-level diagnosis code.

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How does the lab interpret test-level diagnosis codes versus order-level diagnosis codes?

Test-level diagnosis codes take precedence over order-level diagnosis codes. See the example below:

• The CBC was not assigned any test-level diagnosis codes, so it will be linked only to the order-level diagnosis code E11.9, which will be treated as the primary diagnosis code for the CBC.
• The BMP was assigned two test-level diagnosis codes and is also linked to the order-level diagnosis code E11.9:
  • C22.1 will be treated as the primary diagnosis code since it is the first test-level diagnosis code.
  • H40.1190 will be treated as the secondary diagnosis code as it is the second test-level diagnosis code.
  • E11.9 will be treated as the tertiary diagnosis code because it is associated at the order-level.

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Can I move a diagnosis code from the test-level to the order-level or vice versa?

Diagnosis codes cannot be relocated. To change their placement, remove the code from the current location and re-add it to the desired one.

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How many diagnosis codes can I add to a single lab order?

You can add up to 120 unique diagnosis codes per lab order. Related Articles

• Order Forms Guide- Ordering lab tests with the Lab Order Form