Top CPT Codes and Modifiers for Pathology and Orthopedics 

Touseef Riaz

October 31, 2022

CPT Codes and Modifiers
In medical billing, CPT codes are the standard to describe a medical procedure. They’re also called International Classification of Diseases (ICD) codes or Current Procedural Terminology (CPT) codes. So it is because CPT codes and modifiers were created by the American Medical Association (AMA). The ICD-9 and ICD-10 systems are used for coding procedures and diseases in hospitals throughout the United States, but other countries use different methods for billing purposes.

CPT Codes and Modifiers

What are CPT codes? 

CPT stands for Current Procedural Terminology, a system developed by the American Medical Association (AMA) that describes all things related to patient care. It includes surgical procedures like open heart surgery, knee replacement surgery, and brain cancer treatment (which is why it’s called “procedural”). Orthopedic surgeries involve injuries or problems within bones—like broken legs or shoulders—and can be performed on both adults and children.

Types of CPT codes

The CPT codes have been divided into three categories. They are as below: 

CPT® Category I

CPT® Category II

CPT® Category III

Best CPT codes for medical billing tasks: 

Here are the top codes and modifiers for pathology and orthopedics.

You’ve got your list of the most commonly used code and modifier combinations for pathology and orthopedics, but what about the rest? We’ve compiled a list of the field’s top CPT codes and modifiers that you might want to consider when working on your next medical billing project.

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.
  • Cytogenetic microarray analyses- 81228, 81229, 81405, 81406
  • Lengthy 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

Top CPT codes and modifiers codes used in Orthopaedics billing:

  • Evaluation and Management: 99201 – 99499
  • Anesthesia: 00100 – 01999; 99100 – 99140
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999
  • Pathology and Laboratory: 80047 – 89398
  • Medicine: 90281 – 99199; 99500 – 99607

Hand Surgery

  • CPT – 11760 – Repair of Nail Bed
  • CPT – 25215 – Carpectomy; all bones of the proximal row
  • CPT – 64721 – Neuroplasty (carpal tunnel release)

Carpal Tunnel Release – 64721

  • “Neuroplasty and/or transposition; median nerve at the carpal tunnel.”
  • Endoscopic Carpal Tunnel Release – 29848

What is a modifier in medical billing?

A service, technique, or item may be modified for remuneration in certain circumstances using a modifier. For example, modifiers for CPT may add details or change the therapy description or procedure to make it more particular following the medical records. Therefore, it may be successful in responding to reimbursement with the proper modifier.

In addition, modifiers are essential to ensuring that the patient receives the medical care they need at the right time and in the right way. Physicians and therapists use modifiers to clarify precisely what they did during a procedure or treatment session. Modifiers are necessary to ensure patients get the proper care at the right time. 

Here is a precise table showing when to use modifiers in Orthopaedic procedures:

ModifierProcedureUnit (ASC/P)
-50Bilateral proceduresBoth
-51Multiple procedures(P)
-52Reduced services
-58Staged or related procedure or service by the same physician during the postoperative periodBoth
-59Distinct procedural serviceBoth
-73Discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia  (A)
-74Discontinued outpatient hospital/ASC procedure after the administration of anesthesia(A)
-76Repeat procedure or service by the same physicianBoth
-77Repeat procedure or service by another physicianBoth
-78Return to the OR for a related procedure during the postoperative periodBoth
-79Unrelated procedure or service by the same physician during the postoperative periodBoth
-RT & -LTRight Side and Left SideBoth
-TCTechnical componentBoth

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

CPT codes and modifiers— why are they game changers?

Modifiers indicate additional services performed, the complexity of a procedure, and its severity. They also can be used in office settings when there is no need for hospitalization or sedation. Moreover, modifiers are added to CPT codes to help providers bill accurately. They should be included on your patient’s bills since they will increase the amount you receive from insurance companies by $0-$10 per modifier.

The modifiers are two-digit codes with two levels:

Level I Modifiers: Usually known as CPT Modifiers and have two numeric digits. Level I modifiers are added to the information or adjusted care descriptions to give extra details about a procedure or specific provided service to a patient.

Level II Modifiers: Level II modifiers are HCPCS Modifiers consisting of two digits (Alpha / Alphanumeric characters) in the range AA to VP. These modifiers are annually updated by CMS – Centers for Medicare and Medicaid Services.

How do you know if a CPT code needs a modifier?

Coding modifiers are used to further define the code that was billed. For example, they can indicate a different type of procedure, a different site, or a different service date. Moreover, modifiers are also used to bill for functions not listed in the CPT book.

How do you find the CPT Codes and modifiers?

To find the CPT modifier, you can use several resources.

  • The CMS website has a search function that allows you to enter a CPT code and view its modifiers. You can also use this tool if you want to search for all modifiers associated with one or more codes.
  • There is a long list of things that the American Medical Association modifier values on its website. A reference guide is also available in print form from the AMA. You can also have a look at it to get the CPT modifiers. 

What are the most commonly used CPT code modifiers?

A modifier is a code that describes the nature of the service provided. For example, modifiers can tell the type of procedure performed, who performed it, and why it was done.

For example, if you have an appendectomy for a ruptured appendix in a patient with an acute abdomen and hemodynamic instability, your CPT code will be:

  • PC0144 (Surgery – Anorectal/Pelvic Floor)

The first number refers to “an” or “to,”—meaning that this procedure involves the removal of both rectum and sigmoid colon. The second number relates to procedure type: PC indicates pathology/pathology-related; 0144 means appendectomy with removing both rectum and the sigmoid colon. So PC0144, in this case, would mean the removal of both organs along with sigmoidectomies (sigmoid removed). The third field refers to what level we are referring to. Pelvic floor repair should include repair only if damaged or destroyed by accident/trauma while performing other surgical procedures involving the gastrointestinal tract, such as colorectal surgeries, etc. However, there may be cases when another entity performs certain types.

Conclusion:

We believe that this article has improved your comprehension of what is required for billing your orthopedic procedures. When you work in pathology and orthopedics, you’re probably already familiar with the unique needs of your billing department. After all, it’s a field that requires a lot of attention to detail and meticulous record-keeping. And when your lab’s billing process involves thousands of patients, it can be challenging to keep track of everything.

At U Control Billing Services, we understand how vital your billing team is to your business—and we want to help! Our state-of-the-art medical billing services offer high-quality services at an affordable price.

We worked with the industry’s best pathologists, labs, and clinics to provide you with the tools you need to maximize revenue while providing an excellent patient experience. If you’re looking for someone who can help get your billing operations running smoothly again and help them grow even faster than they have been in the past, look no further than U Control Billing Services is here! If you are still unsure about any CPT codes and modifiers, feel free to contact us anytime! We are willing to help with any inquiries or concerns regarding billing medical services.

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