X

CONTACT US NOW

X
X
X
Toll Free 888-357-3226
presentation

Codes and Terminologies used in Pathology Billing

May 11, 2016



Codes and Terminologies used in Pathology Billing

Obtaining timely and accurate pathology reports which further leads to accurate reimbursements is an important role of a pathologist looking after the billing and coding.

Like other medical specialties, Pathology too requires apt documentation for any medical report. And in the case of additional or reporting services, the documentation should state:

  • If a separate service was performed.
  • Which service was it?
  • What was the specimen?
  • The number of times the service was performed with each specimen.
  • Document the stain used and its results.
  • Document the specific stains and blocks the stains were performed on.
  • If there wasn't any diagnosis on a specific stain, do not use 'normal' or 'noncontributory.' Use “GMS stain negative for H. pylori” or “Iron stores confirmed by Iron stain.”
  • Detail out methods and skills which gave the result.
  • Document decalcification for bone specimen. Code 88311 per specimen.
  • Document for intra-operative consultations. Gross only exam finding or microscopic diagnosis (code 88329). If frozen section (88331), touch prep (88333) or both (88331/88334).

Codes used in Pathology Billing and Coding:

CPT codes (dermatologists) 88300 to 88332
Level III surgical pathology (abscess, anus, hematoma etc.) 88304
Level IV surgical pathology or microscopic examination (lip, skin tongue etc.) 88305


CPT New Codes:

Obstetric panel (including HIV testing) 80081
Molecular Pathology Procedures - Gene Specific and Genome procedures 81170, 81162, 81218, 81219, 81272, 81273, 81276, 81311, 81314.
Cytogenomic microarray analyses 81228, 81229, 81405, 81406
Long QT syndrome gene analyses 81280, 81282
Genomic Sequencing Procedures and other Molecular Multianalyte Assays 81412, 81432, 81433, 81434, 81437, 81438, 81442
Multianalyte Assays with MAAAs 81490, 81493, 81525, 81528, 81535, +81536, 81538, 81540, 81545, 81595, 0009M, 0010M
Immunofluorescence Stains +88350


CPT Revised Codes:

Molecular Pathology 81210, 81275, 81355, 81401, 81402, 81403, 81404, 81405, 81406
Genomic Sequencing Procedures and other Molecular Multianalyte Assays 81435, 81436, 81445, 81450, 81455
Chemistry 82542, 83789
Immunology 86708, 86709
Microbiology 87301, 87305, 87320, 87324, 87327, 87328, 87329, 87332, 87335, 87336, 87337, 87338, 87339, 87340, 87341, 87350, 87380, 87385, 87389, 87390, 87391, 87400, 87420, 87425, 87427, 87430, 87449, 87450, 87451, 87502, +87503
Surgical Pathology 88346


HCPCS

CPT New codes G0475, G0476
CPT codes G0477, G0478, G0479, G0480, G0481, G0482, G0483
Revised CPT codes for PQRS G9419, G9429
Cytology codes CPT 88104, 88108, 88112, 88173, 88305 (retained)
Lung Cancer Reporting (Biopsy/Cytology Specimens) (MEASURE 395) CPT: 88104, 88108, 88112, 88173, 88305
Lung Cancer Reporting (Resection Specimens) (MEASURE 396) CPT: 88309
Melanoma Reporting (MEASURE 397) CPT: 88305


Modifiers and other Important Codes in Pathology Billing:

Modifier TC Technical Component
-26 Professional Component
Global Billing Billing pathology services with no modifiers
Surgery or E/M visits during postoperative period -24 or -79 modifier
Benign diagnosis 88304
malignant 88305
Entries 175 among five codes; 230 different types of tissue or specimen scenario
Non-incidental appendix CPT code 88304
Gross and microscopic code 88302-88309

Unit of service for surgical codes 88300-88309 is the specimen.

Pathology Terminologies:
Reference - pasnashville

Numerous rules and regulations control Pathology billing. It is imperative to be acquainted with and comply with these for an authorized and lucrative result.

A thorough understanding of the codes and terminologies along with the regulations that govern Pathology billing will ensure a smooth billing process and overcome billing challenges, resulting in lesser denials and higher payments.

 

Category : Best Billing and Coding Practices