Top CPT Codes and Modifiers for Pathology Medical Billing

Just as any other medical specialty, Pathology too, needs accurate documentation for generating any patient’s medical report. For a pathologist, when taking care of pathology billing and coding, it’s absolutely important to acquire prompt and accurate pathology reports in order to ensure successful reimbursements.

Whether it’s a clinical lab, a physician office lab or even an independent lab, each of these will have different needs and ways to deal with issues related to patient documentation, payer types, or set of procedures. Also, billing for pathology involves a huge variety of different code types and it’s essential for pathologists to be fluent in it while staying updated with the periodic updates.

What Is CPT®?

Pathologists will need to accurately use CPT® which is the medical code set for physicians and health care professionals. Current Procedural Terminology, commonly known as CPT® acts as a uniform language for coding billing medical services and procedures for reimbursements in order to streamline reporting, increase accuracy and efficiency. Each CPT® code represents a written description of a service or procedure that eliminates the need to write a detailed interpretation of what was rendered to a patient. CPT® codes were created by the American Medical Association (AMA) in 1996 to standardize the reporting of medical, surgical, and diagnostic offerings and procedures.

Considering the various services and procedures, the AMA has organized CPT® codes into three types:

CPT® Category I

CPT® Category II

CPT® Category III

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

What is a Modifier?

Modifiers help alter a service, method, or item for compensation purposes in specific instances. To provide greater specificity for the treatment or process given, modifiers may add information or amend the description in accordance with physician documentation. The use of an appropriate modifier to respond to reimbursement can prove to be a success.

Modifiers in Pathology Billing:

Modifier TC    Technical Component
-26      Professional Component
Global BillingBilling pathology services with no modifiers
Surgery or E/M visits during the postoperative period -24 or -79 modifier
Benign diagnosis        88304
malignant88305
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

Conclusion

Many medical billing teams are fortunate enough to only have to work with one or two code types, but when it comes to billing for pathology it’s a completely different scenario. There is numerous variety of code types that the administrative team will have to be eloquent in and ensure they are using the right codes for proper documentation. Another code type is the HCPC codes that are usually common in pathology laboratories due to the specialized equipment and sample transportation services used in the process.

Pathology laboratories can be found in different shapes and sizes, and each one has its own different billing needs and processes. To execute this your billing teams might not have the right knowledge and expertise but don’t worry, you can always outsource your pathology billing services to 24/7 Medical Billing Services. Our state-of-the-art medical billing services cater to pathologists, labs, and clinics to maximize their revenue irrespective of the size or requirements. Our aim is to empower you to serve your patients more profitably while providing an excellent patient experience, rest of the billing concerns can be left behind with us at 24/7 Medical Billing Services.

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