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).

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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

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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)

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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.

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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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