Payment methods to be reviewed include:
CPT New Codes:
CPT Revised Codes:
HCPCS
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- Coding
- Fee for service (FFS)
- Technical Component (TC)
- Professional Component (PC)
- Global Method
- Part A
- 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 |
Codes and Terminologies used in Pathology Billing
Accurate use of desired codes and modifiers will enable quicker and full reimbursement for Pathology
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