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 the 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.