Pathology Billing Services-All you want to know?

Pathology, being the medical science dealing with the cause-and-effect theory of diseases, is an important sector. Similarly, the medical billing and coding process is an important part of all medical practices, including pathology. It might be a small section but includes codes for numerous medical tests like blood tests, hematology, drug tests, urinalysis, etc. If it stays uncounted for, a lot of probable revenue can be lost. Also, there can be complex rules set by insurance companies to process pathology claims. Hence, it requires all the more attention to get accurate data and maximize revenues by auditing it regularly.

Pathology Billing

Pathology billing includes anatomical, general, clinical pathology, and several other varied fields and sub-specialties. These include hematopathology, molecular pathology, surgical pathology, forensic pathology, cytopathology, etc.

Pathology includes two types of tests – qualitative and quantitative tests. Qualitative tests understand the presence of a substance and quantitative tests take note of how much of it is in the body. For example, how much calcium does your body have?

Pathology billing services has its set of requirements and can get complicated for hospital-based services. Sometimes regulations and payer requirements are not updated, but also hospital compliance and other rules.

Which Tests are Included in Pathology Billing?

Drug testing – It first determines whether a drug is present (qualitative) and then the amount of it present (quantitative). Each type of drug has a specific code, which needs to be carefully filled during billing.

There are varied pathological tests –

  • Molecular pathology procedures test antigens, genes, and a few biological functions to test and confirm the diagnosis.
  • Anatomic pathology billing includes procedure codes for autopsies.
  • In the Chemistry subsection, tests for specific chemical compounds are done. It is quite similar to the immunology section.
  • Microbiological tests find out if organisms like hepatitis, giardia, HIV, or rubeola are present. Each of them is given specific codes.
  • Surgical pathology includes the study of human tissue. The surgical pathology codes are characterized by levels and each of them covers a wide range of things. The code groups are sorted by the level of difficulty and/or expense for the procedure. For example, a higher level of code will be used for the costlier or most difficult procedure.

Important Codes

Pathology codes are not measured on the test results but are measured by the number of tests performed. For example, if you test someone for alcohol and phenobarbital, you will have to add them as two procedures.

Here are some of the commonly used fields and the range of their codes –

FieldCode Range
Drug Testing80100 – 80104
Clinical Pathology Consultation80500 – 80502
Urinalysis81000 – 81099
Molecular Pathology81200 – 81479
Chemistry82000 – 84999
Anatomic Pathology88000 – 88099
Cytopathology88104 – 88199
Surgical Pathology88300 – 88399
Microbiology87001 – 87999
Hematology and Coagulation85002 – 85999

Here are the top ICD-10 codes –

  • ICD-10-CM Code K29.50 – Medical ailments related to gastritis
  • ICD-10-CM Code K20.8 – Medical diagnosis of the allergic inflammatory condition in the esophagus
  • ICD-10-CM Code N20.1 – Code for kidney stones
  • ICD-10-CM Code C50.911 – Code that helps specify Breast cancer in women

EMR System in Pathology Billing

Most of the hospitals have adopted the use of an EMR system or the Electronic Health Record (EHR) system. This has reduced the margin of error happening due to incomplete or missing records during patient care. The systems help in creating a singular system for pathologist findings, physician notes, and charting wherein different systems can access or share the information of the same patient between them.

Tips for Better Pathology Billing

  • Understand which of the pathology service is split billable and which are non-split billable.
  • Accurate filling of patient demographics is extremely important as it contains every detail of the client and the illness.
  • Needless to say, the correct use of codes and modifiers is a critical task. It is important to apply standard CPT, HCPCS procedure and supply codes, and ICD-CM diagnosis coding as per CMS guidelines.
  • Keep a track of the claims generated and collections that are processed to avoid any delays. Also, pay attention and follow up on the Aged Claims.
  • Pathology claims scrubbing is used to find out and eliminate errors in billing codes, hence reducing the number of denied or rejected claims.
  • A good Revenue Cycle Management definitely is a savior!

Outsourcing Pathology Billing is the best way to do it right and not worry much about denials. 24/7 Medical Billing Services provides specialized medical billing support for anatomical, general, dermato, clinical, and other specialty pathology. With on-time billing, efficient following up on Aged Claims, low rejection rates, and secure processes; 24/7 Medical Billing Services can help increase collections ratio and decrease your workflow hassles.

Read more: The Need To Outsource Pathology Billing Services

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