Coding Guidelines for Pathology Lab Billing Services

Pathology laboratories are vital in any medical practice as a unique medical field establishment. However, this kind of establishment can vary in iterations and size and, at times, can be part of the hospital. Most laboratories are established near hospitals or medical practice facilities, given the work it does. While hospital labs generate only 3 to 5 percent of hospital revenue, their findings make 70 to 80 percent of a patient’s electronic health record (EHR). Furthermore, CDC estimated that almost 70 percent of doctors’ medical decisions are based on lab test results. This means careful attention needs to be given to improving the revenue process of a pathology lab so that it can invest in the latest testing technology, other lab resources, and staffing so the patient outcome is better. But all these steps begin with proper coding for the pathology tests done, correct Pathology lab billing, on-time claim submission, and minimizing the denials so that patient outcome is better.

Pathology Lab Billing Services & Coding Guidelines

When the coding staff of a pathology laboratory center prepares the bill, they must ensure that correct coding is done for 100% successful reimbursement. It is only possible when they acquire the accurate pathology report and promptly after the service is given. It is also vital that the coding guidelines are followed based on the kind of pathology laboratory where the service is offered. Typically, a pathology lab can be categorized into the following:

  • Independent laboratory
  • Physician office laboratory
  • Clinical Laboratory
  • Referring laboratory
  • Reference Laboratory
  • Billing laboratory
  • Medicare-Approved laboratory

Therefore, the pathology coders have to understand the different needs of the payers, the documentation required, different types of payers, and the various procedural set. As mentioned earlier, the use of correct CPT codes is a must in pathology billing and coding in accordance with the following guidelines:

CPT Codes often used

  • 88300 to 88332: CPT codes for dermatologists
  • 88304: Used for level III pathology services like hematoma, anus, abscess, etc.
  • 88305: Used for level IV of the pathology or any microscopic examination, for example, skin, lip, tongue, etc.

New CPT codes have been added:

  • 80081: Obstetric panel examination, including testing for HIV
  • 81170, 81162, 81218, 81219, 81272, 81273, 81276, 81311, 81314: Genome, gene-specific, and molecular pathology procedures.
  • 81228, 81229, 81405, 81406: Analyses of Cytogenomic microarray
  • 81280, 81282: Analyses of long QT syndrome gene
  • 81412, 81432, 81433, 81434, 81437, 81438, 81442: Different Molecular Multianalyte Assays and procedures for genomic sequencing
  • 81490, 81493, 81525, 81528, 81535, +81536, 81538, 81540, 81545, 81595, 0009M, 0010M:  MAAAs that have Multianalyte Assays

Revised CPT Codes

  • 81210, 81275, 81355, 81401, 81402, 81403, 81404, 81405, 81406: Molecular Pathology
  • 81435, 81436, 81445, 81450, 81455: Different Molecular Multianalyte Assays and Procedures for Genomic Sequencing
  • 82542, 83789: Chemistry
  • 86708, 86709: Immunology
  • 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: Microbiology
  • 88346: Surgical Pathology

The pathology coder must use the correct modifier along with the CPT codes. There are at least nine different modifiers that one must be aware of.  

Important Points to Remember:

The process of pathology coding and adding the modifiers is complex as the coders need to understand the different tests that can qualify under each modifier. For instance, they must know about the tests that can be identified under the modifiers. They must be eloquent with the HCPC codes often used when sample transportation and specialized equipment are used for pathology laboratory tests.

Lack of proper use of pathology codes would mean a loss in revenue for the pathology labs, which will eventually affect the entire system. The only way to ensure that the pathology laboratory service can give the best results is by taking care of their pathology coding and billing system and getting the help of a specialized pathology lab coding and billing company.

How Does Adhering to the Coding Guidelines Help?

Are you wondering which pathology coding and billing company adheres to the pathology laboratory billing and coding guidelines?  It is the 24/7 Medical Billing Services. They have a team of pathology laboratory billing and coding experts who know the latest codes and modifiers and the constant updates and changes made in the rules and regulations of coding created by the governing bodies, Medicare, Medicaid, and insurance companies.

With the help of an expert pathology coding and billing partner like 24/7 Medical Billing Services that maintains the coding guidelines, you can quickly grow your lab with uninterrupted revenue flows. These are the few simple ways by which the 24/7 Medical Billing Services can improve the revenue of any pathology lab practice with its billing and coding services:

Decrease in Operational Costs

Keeping a separate coding and billing department in any pathology lab is vital since the laboratory staff is busy with pathological procedures. This means the establishment must invest in pathology billing and coding software and give training with the latest software updates, coding guidelines, and regulation changes in the billing and coding protocols. All these and the other overhead costs can be cut down with an increase in the cash flows by partnering with 24/7 Medical Billing Services.

No More Errors in Pathology Coding and Billing

With dedicated outsourced pathology laboratory staff equipped with the coding guidelines and the latest software, coding errors can be minimized with the assurance of correct and accurate pathology billing. Also, timely submission of clean claims with regular follow-ups can be guaranteed with further no loss of revenues for the pathology labs.

Enhanced Processing

There is often revenue loss, and claims are denied because of improper eligibility verification and wrong coding. The outsourced pathology coding partner can do the verification while you take care of your patient’s tests. Also, 24/7 Medical Billing Services uses the latest pathology lab billing software to accurately process billing and coding. It allows the entire process to be done quicker, which means the payment process is faster with 100% reimbursements.

It is time to understand pathology labs coding and billing process and increase the service’s revenue in no time with the help of an outsourcing pathology coding and billing partner like 24/7 Medical Billing Services.

Read more: Top CPT Codes And Modifiers For Pathology Medical Billing

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