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Pathology/Lab Coding Alert

CPT 2011:
88172, 88177 Changes Could Smash MUE Roadblock
Capture each 'evaluation episode' for FNA adequacy checkPer "pass" or per lesion -- h... Read more
CPT 2011:
Clip-&-Save: Welcome 12 New and Revised Pathology Codes
Handy table summarizes microbiology, surgical pathology, and cytology changes.If you've be... Read more
CPT 2011:
CMS Slashes Reimbursement, Requires Clinical Lab Requisition Signatures
Conversion factor double dips to Jan. 1 low.Medicare's conversion factor (CF), the multipl... Read more
Reader Question:
88304 or 88305 for Ligament?
Question: My pathologist states that the work for a ligament specimen exam is equivalent t... Read more
Reader Question:
38221 + E/M " Here's How
Question: Sometimes our hematologist sees a patient for the first time; performs an E/M co... Read more
Reader Question:
88342 Units Can Vary
Question: I'm confused about whether I can code 88342 per block of per specimen -- wh... Read more
You Be the Coder:
Do 82550 and 82552 Stand Alone?
Question: Our lab performs creatine kinase and isoenzymes to aid in diagnosis of acute myo... Read more
CPT 2011; 84112 is Your Ticket to the PROM
Pick up on phospholipid code changes, too.If you've been wondering how to report the PAMG-... Read more
CPT 2011:
Clip-and-Save: Welcome 9 New Specific Codes for Clinical Lab
Handy table looks ahead to next year's pricing, too.From gastric acid monitoring to a tube... Read more
CPT 2011:
88332, 88334: Make Sure You Capture Every Intraop Consult Preparation
"List separately" instruction clarifies coding for additional slidesIf you get bogged down... Read more
Capture All the Pay You Deserve for Frozens and Touch Preps Together
Frozens are 'first' -- touch preps are 'additional.'You've just read how CPT 2011 hel... Read more
Reader Question:
Let Payer Guide Screening Pap Code Choice
Question: Our lab performs a liquid-based screening Pap, and finding abnormality, refers t... Read more
Reader Question:
82952 Captures Additional Glucose
Question: We do the same lab test for 82947, 82950, 82951, and 82952 -- is the number of g... Read more
Reader Question:
88314 Parallels Specimen Number
Question: Our pathologist receives 11 to 14 muscle and nerve biopsy specimens and performs... Read more
You Be the Coder:
88321: You Won't Always Choose the Same Units
Question: We received slides from an outside institution that are from three separate case... Read more
CCI 16.3:
Heed New Edits to Avoid Lipoprotein Double Dipping
And look for hemoglobin modifier change -- again.Make sure you keep your lab in compl... Read more
Reimbursement:
Find the Fee Schedule for Your ER/PR Pay
Professional and technical billing impact your bottom lineYou have five code choices for e... Read more
Microbiology:
Unlock Culture and Shiga Toxin Antigen Test Pay With 4 Expert Tips
Don't lose $$ over negative results.Stool testing for patients with diarrhea might involve... Read more
Diagnosis Coding:
CMS to Freeze ICD-9 Code Set Next Year
2011 will be the last time for complete update.CMS has followed through on its proposal to... Read more
Reader questions:
Learn HIV Risk Factors
Question: I understand that Medicare has an expanded HIV screening policy for patients in ... Read more
Reader questions:
Choose Susceptibility by Method
Question: What code should we use for a culture "screening" test for Group B Streptococcus... Read more
Reader questions:
Limit Consult to Case
Question: How should I code a consult report on two slides from the same date: slide A is ... Read more
Reader questions:
Focus on PSA Results
Question: A physician orders a diagnostic PSA test for a patient diagnosed with BPH based ... Read more
Reader questions:
Capture Stains and Conditions
Question: Our pathologist examined a liver biopsy and used a trichrome stain for fibrosis ... Read more
You Be the Coder:
Don’t Let Screening Fool You
Question: When the surgeon performs a screening colonoscopy, finds a polyp in the right co... Read more
CPT Analysis:
4 Steps Ensure That You Clear Every ER/PR Coding Hurdle
Know CPT's assay/stain distinction to pick the right code.The adage to "always report the ... Read more
IHS Stain Unit Change Could Benefit Your Bottom Line
Count specimens -- or maybe blocks to get all the pay you deserveFor years the immuno... Read more
Medicare Compliance:
Maximize Lipid Screening Pay -- Here's How
Acknowledge frequency and diagnosis restrictions.Medicare -- and other payers --... Read more
Audit Alert:
Learn RAC Fast Facts Before Your Audit Comes
Establish contact person to track audit compliance.Maybe your lab hasn't faced an audit fr... Read more
Reader questions:
Distinguish Specimen, Site for Intraoperative Squash Preps
Question: Our pathologist examines specimens labeled "right sentinel node # 1" and "right ... Read more
Reader questions:
Beware PhD Cytogenetics Service
Question: How should we charge for PhD interpretation of cytogenetic tests? Are there any ... Read more
Reader questions:
Let Pathology Report Determine Behavior
Question: I'm confused as to whether tubulovillous adenoma colon polyps are benign or unce... Read more
Reader questions:
Deconstruct Panels to Find Most Comprehensive
Question: When a physician orders a renal function panel and hepatic function panel, can I... Read more
Reader questions:
Limit Warfarin Responsiveness Test to Trial
Question: Our lab is performing a genetic test for warfarin responsiveness for certain pat... Read more
You Be the Coder:
Gestational Age is Key
Question: When the pathologist examines a placenta with the request to look for signs of a... Read more
CPT 2011 Preview:
Get Ready for Drug Test Changes -- Again
Don't let proposed CPT and 'G' codes confuse you.With two new codes proposed for urine dru... Read more
CPT 2011:
Welcome 16 New Specific Codes for Up-and-Coming Lab Tests
Bonus clip-and-save chart gives you a handy new code preview.From three new influenza test... Read more
You Might Get More Pay for PCT, Thromboxane, ATP Tests
Stat sepsis diagnosis uses more of your lab's resourcesPlenty of laboratorians agree ... Read more
Reader Questions:
Judge 88172 by Payer
Question: During a breast fine needle aspiration (FNA), the surgeon submitted an aspirate ... Read more
Reader Questions:
Look to Benign Neoplasm for Clark's Nevus Diagnosis
Question: The pathology report for a skin lesion states "Clark's nevus" as the diagnosis. ... Read more
Reader Questions:
Draw Dx Line at PIN III
Question: The pathology report for a prostate biopsy gives this diagnosis: "high-grade pro... Read more
Reader Questions:
Establish Specific Dx for Thyroid Function Tests
Question: If a physician orders total T4 and TSH tests for a patient with hypothyroidism f... Read more
Reader Questions:
Medical Necessity Snags Urine Culture Pay
Question: A physician ordered a urinalysis with a reflex to urine culture for findings o... Read more
You Be the Coder:
Capture Every Step for Sentinel Lymph Node Pay
Question: Our pathologist received a sentinel lymph node biopsy specimen for a breast canc... Read more
CCI 16.2:
Shun Extra Tissue Prep Charge for Micro and Flow
New bundles confirm 88387-88388 restrictions.CPT 2010 opened the door to charges for steri... Read more
Reserve +88388 for Use With Intraoperative Consults
CCI 16.2 bundles 88387 with surgical consult codes.In case you're having trouble choosing ... Read more
CCI 16.2:
Avoid HCPCS Level II Edit Pairs or Miss Drug Screen Pay
Distinguish telehealth from lab consults, too.Effective July 1, you have plenty of new edi... Read more
CCI Slashes Ability to Separate CBC Edits
Modifier indicator change from '1' to '0' ties labs' hands.Correct Coding Initiative (CCI)... Read more
Compliance:
Reference 3 'G' Codes for Early HIV Screening
Don't miss out on rapid test pay for high-risk beneficiaries. Your lab can now sho... Read more
Reader Questions:
Jump Start Phlebotomy Charges - Here's How
Question: When our lab performs the blood draw as well as the lab test, such as CBC, can w... Read more
Reader Questions:
Many Options Tell Multiple-Specimen Story
Question: I'm new to pathology coding, and I see codes such as 88305 with modifier 76. I'v... Read more
Reader Questions:
Lipoma Trumps Non-Specific Dx
Question: Our pathologist received a specimen labeled "right breast mass," and the patholo... Read more
Reader Questions:
Bill Immunostains Per Antibody
Question: Should we bill a prostate triple stain as 88342 or 88342 x 3?Florida SubscriberA... Read more
You Be the Coder:
CCI Slashes Ability to Separate CBC Edits
Question: We're using 86356 to bill for CD45RA and CD45RO counts -- should we bill th... Read more
ICD-9 2011 Update:
Focus Transfusion Reaction Dx With Host of New Codes
Revisions spotlight iron metabolism disorders.If you ever bill transfusion medicine codes ... Read more
ICD-9 2011:
Tackle Acute/Delayed Distinction for 999.6x-999.8x
Use fifth digit to distinguish hemolysis, other transfusion reactions.Stating "ABO (or Rh)... Read more
HPV Testing:
Collect HPV Pay with Proper Screening vs. Reflex Diagnoses
Align 'medical necessity' with ICD-9 instruction.Ordering a human papillomavirus (HPV) scr... Read more
Reader Questions:
Identify Most Specific Cancer
Question: The pathologist examined a skin lesion removed from the patient's nose identifie... Read more
Reader Questions:
Count Frozens Per Block
Question: How should I code a lung lobectomy specimen, including two frozens -- one o... Read more
Reader Questions:
Code Tests that Pathologists Order
Question: Does the referring physician need to request the PAS/Alcian blue stain before th... Read more
Reader Questions:
Don't Miss Screening Culture Code
Question: A physician performed a rapid strep test in the office and sent out a throat s... Read more
You Be the Coder:
Distinguish 1-Sided Hip Joint Resection
Question: Our pathologist received a container labeled "bone and tissue, left hip." It con... Read more
CPT 2010:
Don't Miss Out on the Molecular Diagnostics Prep Pay You Deserve
Let our experts' scenarios show the way for macrodissection billing. Wondering when your ... Read more
Medicare Compliance:
Distinguish Voluntary ABN With This Modifier
All new GX and revised GA clarify liability statement. Ever since CMS rolled the Notice of... Read more
Bust These 5 ICD-10 Myths With Expert Answers
Start now to get your lab ready for the new diagnosis code set. If the ICD-10 implementat... Read more
Reader Questions:
Use Basic Antibody for IgG Class
Question: Our lab performs a Chlamydia antibody panel that tests for IgG an IgM for three... Read more
Reader Questions:
Watch for KX Gender Notification
Question: I've heard that Medicare has a new way to override genderspecific edits, when a... Read more
Reader Questions:
Limit 85060 to Medicare Inpatients
Question: Our pathologist reviewed a peripheral blood smear as a reflex test from an abno... Read more
Reader Questions:
Let Pathologist Judge Unlisted Anal Specimen
Question: Our pathologist received two distinctly identified anal condylomata and an anal... Read more
Reader Questions:
Zero In On Separate 'Total' and 'Free'
Question: Our lab performs a quantitative and qualitative analysis of free and total carb... Read more
Reader Questions:
Limit Consults to Referred Material
Question: The pathologist performed a colon biopsy exam. Three weeks later, the oncologis... Read more
You Be the Coder:
Solve PhD Interpretation Dilemma
Question: We have a PhD performing molecular diagnostics and molecular array testing in o... Read more
CPT 2010:
Garner Molecular Studies Preparation Pay -- Here's How
6 tips show you the do's and don'ts of using 88387 and +88388. When your pathologist pe... Read more
Venue Solidifies Your 88387+88388 Code Choice
Capture this add-on for intraoperative consultations. Chose the wrong code and you co... Read more
CCI 16.1:
Skip Coding Analyte and Method Together
But you can break bundles when testing separate constituents. You'll need to be on your... Read more
The OIG is Watching Your Modifier 59 Claims -- Are You?
Make sure you meet distinct service criteria before you unbundle. With the Office of In... Read more
Reader Question:
Hepatitis Doesn't Guarantee Panel Pay
Question: A physician ordered a hepatitis panel with diagnosis code 070.51, but Medicare... Read more
Reader Question:
Be Careful of 'Routine' Special Stains
Question: When we bill for electron microscopy, can we separately code the toluidine blu... Read more
Reader Question:
Payer Leads the Way for Proper Pap Coding
Question: How should we code a case when we process a routine screening Pap smear but due... Read more
You Be the Coder:
Learn Frozen Section Counting Rules
Question: Our pathologist consulted during surgery for a lesion excision case involving f... Read more
CPT 2010:
Welcome 86825-82826 -- Serology Isn't the Only HLA Crossmatch
Distinguish typing/crossmatch methods to help you pick the right code. After years of bei... Read more
Keep HLA Codes Straight With This Transplant Primer
Understand testing process to see how codes work together. If you don't know "typing" fro... Read more
Bone Up on Bone Bundles to Bring Home Medicare Pay
Choose 38220-59 or G0364 depending on surgical conditions. Whether you'll see Medicare pa... Read more
Clip-n-Save:
Use This Handy Chart to Keep Medicare's Bone Rules at a Glance
Don't double dip on extraction and evaluation pay. Bone sampling and interpretation offer... Read more
READER QUESTIONS:
Match Diagnosis to Findings
Question: An ob-gyn submitted 3 cm sections of right and left fallopian tubes with a surg... Read more
READER QUESTIONS:
Abandon POS/DOS Direction
Question: Could you please explain Medicare's new rules for place of service and date of ... Read more
READER QUESTIONS:
Gain Bronchial Pay With This Tip
Question: From a Medicare patient, we received a bronchial brushing labeled "right lower ... Read more
READER QUESTIONS:
'Without Mention' Grants Diagnosis Leeway
Question: If pathologic findings from a bone marrow biopsy and immunohistochemistry indic... Read more
You Be the Coder:
Resolve FNA With Cell Block Question
Question: I've heard that we can't bill any additional preparations with an FNA specimen.... Read more
3 Tips Get You Ready for G0430 and G0431
Learn drug screen code changes for now; expect more change for April 1. You have two new ... Read more
Not Unbundling 86780 Could Get You in Hot Water Get You in Hot Water
Find a solution to surprising CPT OB panel instruction. You wouldn't think that one simpl... Read more
Distinguish 'Unspecified' Vs.'Uncertain' Neoplasms -- Here's How
Don't let 238/239 confusion leave medical necessity to chance. You may feel "... Read more
Reader Question:
Heads Up on DOS Policy Change
Question: Did CMS's date of service rules go into effect on Jan. 4 as planned? Florida Su... Read more
Reader Question:
Don't Expect Pay for Routine HPV With Pap
Question: Our lab has a client physician who orders a human papillomavirus test with ever... Read more
Reader Question:
Reserve QW for Waived Labs
Question: The lab that I work for has a CLIA Certificate of Compliance. Do I need to use ... Read more
Reader Question:
Strengthen Your Thyroid Coding Know-How
Question: A physician ordered a thyrotropin releasing hormone stimulation panel, anti-thy... Read more
You be the coder:
Can You 'Add Up' Large Arrays?
Question: Our lab performs a molecular diagnostics "array" test that involves more than 1... Read more
CCI 16.0:
Get With the Bundling Program Before You Use New Culture Codes
Look for transcutaneous hemoglobin limitations, too. Think you’re ready to use a... Read more
CCI 16.0:
Add-On Doesn't Mean Add-Up 88387-+88388
Choose 1 macrodissection code based on primary procedure. Don’t let the + sign c... Read more
Surprise Instruction:
Report Special Stains Per Block
Should you throw the ‘specimen’ convention out the window? For surgical pa... Read more
Back to Basics:
Let this CCI Primer Make You an Edit-File Pro
Missing modifier could mean missing legitimate lab test pay. What do you have to lose ... Read more
CCI edits, mutually exclusive, column 1/column 2, modifier indicator
Question: When our lab performs rapid testing for influenza A and B, should we use modif... Read more
Reader Question:
Solve Pinworm Edit Mystery
Question: I was told that we can’t bill a pinworm exam with a prostate saturation ... Read more
Reader Question:
Get Ready for ABN Modifier GX
Question: I noticed in an MLN Matters article that we’re getting new advance benef... Read more
Reader Question:
Breathe a Sigh of Relief for Conversion Factor
Question: I’m very confused about what Medicare will pay for pathology physician s... Read more
You Be the Coder:
Capture Adrenal Gland Pay
Question: The pathology report documents a “radical nephrectomy” and provide... Read more
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