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 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.

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Published By - Medical Billers and Coders
Published Date - May-11-2016 Back