Pathologist Billing, CPT Codes and Modifiers List

Touseef Riaz

April 20, 2022

Pathologist Billing

Pathologist billing ensures timely reimbursements for the services provided by the pathologist. According to CMS, the CPT codes for pathology and laboratory describe the services evaluating the patient’s specimen. Pathology and laboratory procedures CPT codes range from 80047 to 89398. This code set is maintained by American Medical Association (AMA).

Pathologist Billing CPT Codes:

Pathology and Laboratory Procedures CPT billing codes are divided into several categories. Following are the categories of pathology and laboratory billing codes:

Common laboratory billing and pathology CPT codes list is as follows:

    • A level II examination of a surgical pathology specimen. Examination of gross and microscopic features of the specimen and reporting findings.
  • CPT Code 88305:
    • A level IV examination of a surgical pathology specimen; involves examining the gross and microscopic features of the specimen and reporting findings.
  • CPT Code 88309:
    • A level VI examination of a surgical pathology specimen; involves:
      • Accessioning the specimen into the lab
      • Which involves formally receiving the specimen
      • Then examining gross and microscopic features of the specimen and reporting findings.
  • CPT Code 81228:
    • Lab test using comparative genomic hybridization (CGH) microarray, also called chromosomal microarray (CMA), or molecular karyotype; to detect variation in the number of copies of gene sequences, called copy–number variants (CNVs).
  • CPT Code +88350:
    • An immunofluorescent study using a single antibody stain procedure to detect:
      • Autoimmune disease
      • Or an infectious organism in a tissue or cellular sample.
    • It involves the procedure for a single antibody stain following an initial stain with a different antibody.
    • The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate immediately after aspiration. It is to determine whether a sample satisfactory for diagnosis was obtained.
  • CPT Code 88311:
    • A decalcification procedure on a specimen; Dissolving the calcium makes it easier to perform certain examinations.
  • CPT Code 88329:
    • A consultation during surgery to assist the surgeon in evaluating a specimen or advising on a course of action.
  • CPT Code 88312:
    • The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. Typically, a pathologist interprets the slide and issues a report.

HCPCS Codes for Pathology and Laboratory procedures include:

    • Cephalin flocculation, blood
  • P2029
    • Congo red, blood
  • P2031
    • Hair analysis (excluding arsenic)
  • P2033
    • Thymol turbidity, blood
  • P2038
    • Mucoprotein, blood (seromucoid) (medical necessity procedure)
  • P9010
    • Blood (whole), for transfusion, per unit
  • P9016
    • Red blood cells, leukocytes are reduced, each unit
  • P9019
    • Platelets, each unit
  • P9020
    • Platelet-rich plasma, each unit
  • P9021
    • Red blood cells, each unit
  • P7001
    • Culture, bacterial, urine; quantitative, sensitivity study

Pathologist Billing Services:

When it comes to pathology, almost every field of medicine and specialty is affected by it. Pathologists are the ones whose knowledge and expertise aid the healthcare specialists in making a proper treatment plan for a patient’s health condition.

Along with this, pathologists are also working constantly in investigating ways to improve medicine. Similar to other healthcare specialties, pathologists also lack in receiving complete reimbursements for the services they render.

Medical billing is crucial for any healthcare practice, and proper medical billing is necessary to receive timely and complete payments. There are several errors and mistakes when it comes to pathology medical billing. Being up-to-date with the payer’s medical billing requirements for services rendered by the pathologist is crucial for proper medical billing. For this reason, by outsourcing the billing services to a pathologist billing company, healthcare providers can worry less about the revenues.

But why outsource?

Following are some of the reasons why you should outsource pathology medical billing.

  • In-house professional and skilled medical billing team:

A highly skilled medical billing team is required to effectively manage medical billing, reimbursements, and the revenue cycle. The in-house medical billing team should have several skill sets, for instance:

  • Operations
  • IT – hardware and software
  • Certified and professional medical billers and coders
  • Compliance manager

However, with an in-house medical billing team, liability also increases. For instance, if one of the medical billers goes on a vacation or gets sick, the complete medical billing process gets affected. Late submission, incorrect medical coding, use of the wrong modifier, or improper documentation can result in the claim being denied or rejected.

  • Administrative costs:

Except for the challenge of hiring and keeping professional medical billers on board, another challenge involves expenses. With in-house medical billing, fixed costs are also associated, for instance:

  • Salaries
  • Benefits
  • Medical billing software purchase and maintenance
  • Time
  • Computer equipment
  • Claim denials
  • Overheads, e.g., space & supplies
  • Training costs, etc.

Importance of Medical Billing:

Medical billing is a crucial component of healthcare practice playing an essential role in its revenue cycle. It converts the medical procedure or service provided by the healthcare physicians to a medical claim.

On the other hand, medical coding is a process of converting diagnosis, medical service, equipment, and procedures performed into codes. Thousands of these alphanumeric codes are assigned to several diagnoses, medical services, and procedures. The challenge is to use the correct codes in medical claims. Some of the most commonly used medical coding systems include the following:

Types of Medical codes being used:

Following are the most commonly used medical codes:

  • ICD 10 – International Classification of Diseases, 10th Edition:

ICD stands for International Classification of Diseases. ICD 10 is the 10th Edition of the ICD coding system and is published by the World Health Organization (WHO). This coding system comprises two medical code sets:

  • ICD-10-CM:
    • International Classification of Diseases, Tenth Revision, Clinical Modification
  • ICD-10-PCS:
    • International Classification of Diseases, Tenth Revision, Procedure Coding System
  • CPT – Current Procedural Terminology Codes:

Current Procedural Terminology (CPT) codes are maintained by the American Medical Association (AMA). CPT codes are one of the most commonly used code sets and are further divided into several categories.

  • Category I – These are the most commonly used codes by medical coders to report medical services and procedures. Category I codes are five-digit numeric codes only, ranging from 00100 to 99499. (CPT codes for Pathology Billing are listed above).
  • Category II – This category comprises codes for performance measurement. Category II codes are supplemental tracking codes. These alphanumeric codes comprise four digits ending with an “F.” These codes are optional, meaning they are not required for proper medical coding.
  • Category III – This code set comprises temporary codes for emerging technology, procedures, and services. They are alphanumeric codes, four digits ending with a “T.

 

  • HCPCS – (Healthcare Common Procedure Coding System, Level II):

Healthcare Common Procedure Coding System (HCPCS) is another commonly used standardized coding system. HCPCS Level II codes for healthcare providers, physicians, and medical equipment suppliers involve filing health plan claims for:

  • Medical devices
  • Medical supplies
  • Transportations services
  • Medications
  • Other healthcare items or services

Outsourcing Pathology Medical Billing Services:

Medical billing is crucial for healthcare practices’ reimbursements and revenue cycle management. Following are some of the most common medical billing errors:

  • Incorrect medical coding
  • Use of incorrect modifier
  • Unbundling, upcoding, and under coding
  • Incorrect patient information
  • Incomplete or sloppy documentation

On the contrary, outsourcing your medical billing services to a well-reputed medical billing company has several benefits.

Some of the major benefits of outsourcing pathologist billing services include:

  • Reduced errors
  • Lesser claim denials
  • Faster turnarounds
  • A team of highly skilled professionals
  • Higher reimbursement rate
  • Improved revenue cycle
  • More focus on patient care

If your healthcare practice is facing the issues mentioned earlier, contact the affiliated pathologist medical billing company.

Why outsource pathology billing services to UControl Billing?

UControl Billing is a well-reputed, result-oriented medical billing outsourced services company. We consider ourselves a “remote business office,” providing you with billing in 24 hours, and are always available to answer any of your queries. We understand pathology coding guidelines as it is a crucial component of any healthcare practice and, if not done correctly, can impact the revenue cycle. This is why we have a team of professional medical billing experts on board, handling all the critical parts of your billing.

Why UControl Billing?

With UControl Billing, you get:

  • Fee schedule review and analysis
  • Eligibility verification.
  • Referrals, Authorization alert, Claim tracking, reduced rejections, and denials
  • Patient statement processing, Mailing, Customized Monthly financial reports
  • Rules-based claim review, scrubbing, Insurance follow-up.
  • Helping the collection agency to recover patient balances
  • Always remain HIPAA Compliant
  • We ensure 100% privacy, discretion, and patient confidentiality.
  • Improved Quality & Increase in Revenue
  • Billing in 24 Hours & Timely Follow-ups
  • Patient Support & Customer Services
  • Competitive pricing
  • Maximized reimbursements
  • Reduced overall expenses

Pricing & Plan:

“We only get paid when you get paid.”

With UControl Billing, you don’t have to face fixed costs. Your billing costs will depend on your monthly receipts, meaning if your production dips down, so will your billing cost. UControl Billing offers 2 Pricing Plans:

  • Medical Billing Only
  • Complete Revenue Cycle Management

What is Pathology?

Pathology is the study of diseases, supporting healthcare in diagnosing and treating the disorder the right way. It comprises diagnosis and examination of tissues, body fluid (e.g., blood), organs (removed surgically), and autopsy (complete body). Pathologists are professionals specialized in examining body tissues and fluids. They help the other healthcare specialties reach a proper diagnosis and develop a treatment plan for the patient. Pathologists specialize in various areas of pathology, and almost all pathologists have training in anatomic and clinical pathology. There are several subspecialties associated with anatomic and clinical pathology.

Anatomic Pathology:

  • Autopsy
  • Breast Pathology
  • Cytopathology
  • Gastrointestinal Pathology
  • Genitourinary Pathology
  • Gynecologic Pathology
  • Neuropathology
  • Pediatric Pathology
  • Perinatal Pathology
  • Renal Pathology
  • General Surgical Pathology

Clinical Pathology:

  • Clinical Chemistry
  • Cytogenetics
  • Hematopathology
  • Hemostasis
  • Immunology
  • Microbiology
  • Molecular Pathology
  • Transfusion Medicine

Frequently Asked Questions (FAQs)

  1. What is pathologist billing in medical billing?

Pathologists are the healthcare professionals dealing with the examination of body tissues and fluids. Medical billing for pathology ensures timely reimbursements for the services provided by the pathologist. According to CMS, the CPT codes for pathology and laboratory describe the services evaluating the patient’s specimen.

  1. What are common pathologist billing errors?

Errors in medical billing and coding directly impact the revenue cycle of healthcare practice. Some of the most common medical billing errors include:

  • Incorrect medical coding
  • Use of incorrect modifier
  • Unbundling, upcoding, or under coding
  • Incorrect patient information
  • Incomplete documentation
  1. What does pathologist billing mean?

Pathology and laboratory procedures CPT codes range from 80047 to 89398. This code set is maintained by American Medical Association (AMA). Similar to other healthcare specialties, pathologists also lack in receiving complete reimbursements for the services they render. However, outsourcing your pathology medical billing services to a medical billing outsourced services company has several benefits.

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