Pathology/Lab Coding Alert
CPT® 2022:
Consolidate Infectious Agent Changes
Check out CLFS pricing recommendations. Despite numerous “new” CPT® 2022 codes for S... Read more
Consolidate Infectious Agent Changes
Check out CLFS pricing recommendations. Despite numerous “new” CPT® 2022 codes for S... Read more
Quality Payment Program:
MPFS Proposed Rule Forecasts Big Changes
Look for MIPS endgame in 2028 Major policy shifts are on the horizon for how your lab wil... Read more
MPFS Proposed Rule Forecasts Big Changes
Look for MIPS endgame in 2028 Major policy shifts are on the horizon for how your lab wil... Read more
Pandemic Update:
Learn How HIPAA Impacts Personnel Vaccine Mandates
See if you can ask staff their vaccination status. With questions swirling about requirin... Read more
Learn How HIPAA Impacts Personnel Vaccine Mandates
See if you can ask staff their vaccination status. With questions swirling about requirin... Read more
Reader Questions:
Grapple With Coding This FNA Case
Question: Our pathologist extracted bilateral FNA breast biopsies, evaluated the specimen... Read more
Grapple With Coding This FNA Case
Question: Our pathologist extracted bilateral FNA breast biopsies, evaluated the specimen... Read more
Reader Questions:
Watch Your Iron Stain Specimen
Question: What is the difference between codes 85536 and 88313 for iron stain? Ohio ... Read more
Watch Your Iron Stain Specimen
Question: What is the difference between codes 85536 and 88313 for iron stain? Ohio ... Read more
Reader Questions:
Distinguish LDL Fractions
Question: The lab performs a test to measure levels of “small dense low-density lip... Read more
Distinguish LDL Fractions
Question: The lab performs a test to measure levels of “small dense low-density lip... Read more
You Be the Coder:
Pinpoint Bladder Specimen Coding
Question: Our pathologist received several “shave” tissue slices from a bladder TURBT ... Read more
Pinpoint Bladder Specimen Coding
Question: Our pathologist received several “shave” tissue slices from a bladder TURBT ... Read more
Q4 Proprietary Laboratory Analyses:
Don’t Miss PLAs for Oncology, Constitutional Disorders, and More
Find 30 new ‘U' codes in CPT® 2022 You won't find the 30 new, fourth quarter (Q4) Prop... Read more
Don’t Miss PLAs for Oncology, Constitutional Disorders, and More
Find 30 new ‘U' codes in CPT® 2022 You won't find the 30 new, fourth quarter (Q4) Prop... Read more
Unlisted Services:
Avoid Least-Specific Code Choice With These Tips
Check all code categories and method codes. If you don't know the code for a procedure yo... Read more
Avoid Least-Specific Code Choice With These Tips
Check all code categories and method codes. If you don't know the code for a procedure yo... Read more
Compliance:
Prep Your Lab for Balance Billing Rule
Get disclosures in place before Jan. 1 deadline. With passage of the “No Surprises Ac... Read more
Prep Your Lab for Balance Billing Rule
Get disclosures in place before Jan. 1 deadline. With passage of the “No Surprises Ac... Read more
Reader Questions:
Capture Straight-Forward Tongue Biopsy
Question: Our pathologist received a tongue core biopsy specimen for suspected oral tumor... Read more
Capture Straight-Forward Tongue Biopsy
Question: Our pathologist received a tongue core biopsy specimen for suspected oral tumor... Read more
Reader Questions:
Drill Down to Drug Code
Question: A physician submitted a urine specimen for suspected overdose of a combination o... Read more
Drill Down to Drug Code
Question: A physician submitted a urine specimen for suspected overdose of a combination o... Read more
Reader Questions:
Compare Testosterone Tests
Question: The lab performs a test using a serum specimen that involves precipitating and r... Read more
Compare Testosterone Tests
Question: The lab performs a test using a serum specimen that involves precipitating and r... Read more
You Be the Coder:
Narrow Cytopathology Choices
Question: I'm new to pathology coding. What is the difference between 88112 and the 88160 ... Read more
Narrow Cytopathology Choices
Question: I'm new to pathology coding. What is the difference between 88112 and the 88160 ... Read more
CPT® 2022:
Dial In Changes for Pathology Clinical Consultation Coding
Get time-specific with new codes. Pathologists will lose two codes in CPT® 2022 for pat... Read more
Dial In Changes for Pathology Clinical Consultation Coding
Get time-specific with new codes. Pathologists will lose two codes in CPT® 2022 for pat... Read more
MPFS 2022 Proposed Rule:
Conversion Factor Proposal = Pay Cut Next Year
See what sticks from COVID-19 specimen collection changes. The Medicare Physician Fee S... Read more
Conversion Factor Proposal = Pay Cut Next Year
See what sticks from COVID-19 specimen collection changes. The Medicare Physician Fee S... Read more
ICD-10-CM 2022:
Check Out New Dx Codes For This Fall
Find new and expanded codes for detailed reporting. With the 2022 ICD-10-CM update that t... Read more
Check Out New Dx Codes For This Fall
Find new and expanded codes for detailed reporting. With the 2022 ICD-10-CM update that t... Read more
Reader Questions:
Decipher Who Must Heed HIPAA
Question: Can employers request employee lab test results for COVID-19 testing or does HIP... Read more
Decipher Who Must Heed HIPAA
Question: Can employers request employee lab test results for COVID-19 testing or does HIP... Read more
Reader Questions:
Beware Borderline Tumor Dx
Question: The pathology report for a left oophorectomy identifies “serous tumor of low m... Read more
Beware Borderline Tumor Dx
Question: The pathology report for a left oophorectomy identifies “serous tumor of low m... Read more
Reader Questions:
Untangle ‘Sequestration’ Lab Pay Impact
Question: What is the “sequestration payment,” and does it affect what we're paid by M... Read more
Untangle ‘Sequestration’ Lab Pay Impact
Question: What is the “sequestration payment,” and does it affect what we're paid by M... Read more
You Be the Coder:
Zero In on POS Codes
Question: What are the place of service codes, and which codes might I see in laboratory b... Read more
Zero In on POS Codes
Question: What are the place of service codes, and which codes might I see in laboratory b... Read more
CPT® 2022 Preview:
CLFS Annual Meeting Takes the Wraps off New Lab Codes
Look ahead to immunology tests for auto-immune disorders. The floodgate opened for new 20... Read more
CLFS Annual Meeting Takes the Wraps off New Lab Codes
Look ahead to immunology tests for auto-immune disorders. The floodgate opened for new 20... Read more
Anatomic Pathology:
Jump Start Upper GI Exam Pay With These 3 Tips
Don't miss multiple specimens. Pathologists often examine multiple specimens from a sing... Read more
Jump Start Upper GI Exam Pay With These 3 Tips
Don't miss multiple specimens. Pathologists often examine multiple specimens from a sing... Read more
HIPAA:
Crush PHI Disclosure Myths that Block Information Flow
Consider health and safety concerns. If your lab personnel try so hard to secure protecte... Read more
Crush PHI Disclosure Myths that Block Information Flow
Consider health and safety concerns. If your lab personnel try so hard to secure protecte... Read more
Reader Questions:
Details Determine hCG Code
Question: When our lab performs an hCG test on maternal blood for pregnancy, what code sho... Read more
Details Determine hCG Code
Question: When our lab performs an hCG test on maternal blood for pregnancy, what code sho... Read more
Reader Questions:
Calm Down About ICD-11
Question: I listened in on a webinar recently where the speaker said to prepare now for IC... Read more
Calm Down About ICD-11
Question: I listened in on a webinar recently where the speaker said to prepare now for IC... Read more
Reader Questions:
Focus ICD-10-CM Coding for Breast Case
Question: The pathologist examined a right breast specimen from the upper inner quadrant o... Read more
Focus ICD-10-CM Coding for Breast Case
Question: The pathologist examined a right breast specimen from the upper inner quadrant o... Read more
You Be the Coder:
Capture Global Pathology Service
Question: When we bill for microorganism special stains on surgical pathology specimens, p... Read more
Capture Global Pathology Service
Question: When we bill for microorganism special stains on surgical pathology specimens, p... Read more
In Situ Hybridization:
Asking Who Oversees ISH May Change Your Coding
Remember: report ISH per specimen, then per procedure. Ancillary tests using in situ hybr... Read more
Asking Who Oversees ISH May Change Your Coding
Remember: report ISH per specimen, then per procedure. Ancillary tests using in situ hybr... Read more
Microbiology:
Answer 4 Questions for Perfect Urine Culture Coding
Unravel medical necessity. Even if you consider microbiology culture coding an easy task... Read more
Answer 4 Questions for Perfect Urine Culture Coding
Unravel medical necessity. Even if you consider microbiology culture coding an easy task... Read more
HIPAA:
Let Enforcement Action Spur Your Lab’s Compliance
Track the basics to stay on course. The feds are ramping up HIPAA reviews, and one Georg... Read more
Let Enforcement Action Spur Your Lab’s Compliance
Track the basics to stay on course. The feds are ramping up HIPAA reviews, and one Georg... Read more
Reader Questions:
Define Purpose For Topiramate Test
Question: The lab received a physician order for a therapeutic drug level for Topiramate,... Read more
Define Purpose For Topiramate Test
Question: The lab received a physician order for a therapeutic drug level for Topiramate,... Read more
Reader Questions:
Don’t Leave Genetic Test Pay on the Table
Question: Our lab is a full-service genetic testing lab, and we have certified genetic cou... Read more
Don’t Leave Genetic Test Pay on the Table
Question: Our lab is a full-service genetic testing lab, and we have certified genetic cou... Read more
You Be the Coder:
Use 85610 and More for Coagulation Management
Question: How should we bill for INR testing at our Coumadin Clinic, including how to... Read more
Use 85610 and More for Coagulation Management
Question: How should we bill for INR testing at our Coumadin Clinic, including how to... Read more
CPT® 2021 Q3:
See How New PLA Codes Could Change Your Cancer Reporting
Consider new ART-related codes, too. Get ready for a third quarter CPT® update with seve... Read more
See How New PLA Codes Could Change Your Cancer Reporting
Consider new ART-related codes, too. Get ready for a third quarter CPT® update with seve... Read more
Biopsy:
4 Rules Will Help You Navigate This Tricky FNA/PNB Coding Case
Find out whether you can report these procedures together. Your pathologist's exam of cas... Read more
4 Rules Will Help You Navigate This Tricky FNA/PNB Coding Case
Find out whether you can report these procedures together. Your pathologist's exam of cas... Read more
Lab Management:
Include BA Hiring as HIPAA Compliance Task
Or else you could be liable. As a pathologist or laboratory organization, you're a covere... Read more
Include BA Hiring as HIPAA Compliance Task
Or else you could be liable. As a pathologist or laboratory organization, you're a covere... Read more
Reader Questions:
Respond to MAC Overpayment Claim
Question: We received a “demand letter” from our MAC claiming that we were overpaid. W... Read more
Respond to MAC Overpayment Claim
Question: We received a “demand letter” from our MAC claiming that we were overpaid. W... Read more
Reader Questions:
Follow Excludes Note to C7A.0
Question: The pathology report states a diagnosis of “malignant carcinoid tumor” for a... Read more
Follow Excludes Note to C7A.0
Question: The pathology report states a diagnosis of “malignant carcinoid tumor” for a... Read more
Reader Questions:
Distinguish 80143, 80329
Question: An emergency room physician ordered a test for a suspected acetaminophen overdos... Read more
Distinguish 80143, 80329
Question: An emergency room physician ordered a test for a suspected acetaminophen overdos... Read more
Reader Questions:
See Lung Biopsy Difference
Question: The pathologist receives a lung biopsy from the right lower lobe, a bone biopsy ... Read more
See Lung Biopsy Difference
Question: The pathologist receives a lung biopsy from the right lower lobe, a bone biopsy ... Read more
You Be the Coder:
Evaluate Separate Tonsils, Lymph Node
Question: Our pathologist examined a specimen from a tonsillectomy and adenoidectomy that ... Read more
Evaluate Separate Tonsils, Lymph Node
Question: Our pathologist examined a specimen from a tonsillectomy and adenoidectomy that ... Read more
NCCI 27.1:
Add Respiratory Virus Bundles to Your Watch List
Know when and how to override edit pairs. Quarterly updates to Medicare's National Correc... Read more
Add Respiratory Virus Bundles to Your Watch List
Know when and how to override edit pairs. Quarterly updates to Medicare's National Correc... Read more
Case Study:
Missing Metastatic Ovarian Cancer Dx Means Missing Pay
Abdominal ‘mass' takes lower pathology service codes. The surgeon may submit specimens... Read more
Missing Metastatic Ovarian Cancer Dx Means Missing Pay
Abdominal ‘mass' takes lower pathology service codes. The surgeon may submit specimens... Read more
COVID-19 Relief:
Look for Lab-Specific Aid in ARPA
Testing is front and center. With a focus on COVID-19 diagnostic testing and related ge... Read more
Look for Lab-Specific Aid in ARPA
Testing is front and center. With a focus on COVID-19 diagnostic testing and related ge... Read more
Reader Questions:
HIPAA Security Doesn’t Stop at Your Phone
Question: Could you give some tips to help secure our mobile devices, meet HIPAA requireme... Read more
HIPAA Security Doesn’t Stop at Your Phone
Question: Could you give some tips to help secure our mobile devices, meet HIPAA requireme... Read more
Reader Questions:
Clear Up BNP Coding
Question: Sometimes a practitioner orders BNP and NT-proBNP for the same patient. I can't ... Read more
Clear Up BNP Coding
Question: Sometimes a practitioner orders BNP and NT-proBNP for the same patient. I can't ... Read more
Reader Questions:
Focus Correct SARS-CoV-2 Antibody Code
Question: Our physician office lab has started using a rapid test to detect SARS antibodi... Read more
Focus Correct SARS-CoV-2 Antibody Code
Question: Our physician office lab has started using a rapid test to detect SARS antibodi... Read more
You Be the Coder:
Distinguish DCIS from Infiltrating Ductal Carcinoma
Question: We have a pathology report for a breast biopsy exam from a 67 year old male pati... Read more
Distinguish DCIS from Infiltrating Ductal Carcinoma
Question: We have a pathology report for a breast biopsy exam from a 67 year old male pati... Read more
COVID-19 Complications:
Recognize Lab Testing, Dx Coding for MIS-C
CDC and AHA guidance clarify reporting. When your lab faces test requisitions for patient... Read more
Recognize Lab Testing, Dx Coding for MIS-C
CDC and AHA guidance clarify reporting. When your lab faces test requisitions for patient... Read more
Anatomic Pathology:
Master Coding for Uterine Fibroid Cases With 3 Tips
Several missteps could cost you pay. When your pathologist receives a uterine specimen f... Read more
Master Coding for Uterine Fibroid Cases With 3 Tips
Several missteps could cost you pay. When your pathologist receives a uterine specimen f... Read more
Lab Management:
Follow OSHA COVID-19 Guidelines
Keep current on PPE updates. For lab employee safety and compliance purposes, you should ... Read more
Follow OSHA COVID-19 Guidelines
Keep current on PPE updates. For lab employee safety and compliance purposes, you should ... Read more
Reader Questions:
Do This for Multiple MIC
Question: Sometimes we get cases with urine culture code 87086 along with 87186 done multi... Read more
Do This for Multiple MIC
Question: Sometimes we get cases with urine culture code 87086 along with 87186 done multi... Read more
Reader Questions:
Don’t Fear Information Blocking Enforcement
Question: We're concerned about the 21st Century Cures Act deadlines that were extended du... Read more
Don’t Fear Information Blocking Enforcement
Question: We're concerned about the 21st Century Cures Act deadlines that were extended du... Read more
Reader Questions:
Know Key Terms for GIST Dx
Question: We have a pathology report that describes the colon tumor specimen as “ga... Read more
Know Key Terms for GIST Dx
Question: We have a pathology report that describes the colon tumor specimen as “ga... Read more
Reader Questions:
Comment on HIPAA Changes Now
Question: I heard that HHS released a proposed rule for HIPAA changes last December. Is th... Read more
Comment on HIPAA Changes Now
Question: I heard that HHS released a proposed rule for HIPAA changes last December. Is th... Read more
You Be the Coder:
Verify Patient, Provider Type for SARS-CoV-2 Specimen Collection
Question: We're getting denials from Medicare when we append hospice modifier GW to G2024.... Read more
Verify Patient, Provider Type for SARS-CoV-2 Specimen Collection
Question: We're getting denials from Medicare when we append hospice modifier GW to G2024.... Read more
CPT® 2021:
Master GSPs’ Family Features
Learn ‘algorithm' distinction from MAAA codes. Although CPT® 2021 introduces just one ... Read more
Master GSPs’ Family Features
Learn ‘algorithm' distinction from MAAA codes. Although CPT® 2021 introduces just one ... Read more
Coding Basics:
Make Better Modifier 59 Habits This Year
Avoid common, costly billing errors. Payers never stop scrutinizing claims that list “s... Read more
Make Better Modifier 59 Habits This Year
Avoid common, costly billing errors. Payers never stop scrutinizing claims that list “s... Read more
Compliance:
Let CERT Spotlight Improper Payment Peril
Focus on lab and pathology data. Despite a drop in the overall improper payment rate for ... Read more
Let CERT Spotlight Improper Payment Peril
Focus on lab and pathology data. Despite a drop in the overall improper payment rate for ... Read more
You Be the Coder:
Know When to Use U0005
Question: We're performing SARS-CoV-2 nucleic acid tests using high throughput technology.... Read more
Know When to Use U0005
Question: We're performing SARS-CoV-2 nucleic acid tests using high throughput technology.... Read more
Reader Questions:
Recognize QW for COVID-19 Tests
Question: Which COVID-19 tests should we report with modifier QW, because we are a lab wit... Read more
Recognize QW for COVID-19 Tests
Question: Which COVID-19 tests should we report with modifier QW, because we are a lab wit... Read more
Reader Questions:
Focus Modifier 22 Skills
Question: I've been told we should use modifier 22 only if the pathologist documents at le... Read more
Focus Modifier 22 Skills
Question: I've been told we should use modifier 22 only if the pathologist documents at le... Read more
Reader Questions:
Find Form 3508S for PPP Loan Forgiveness
Question: How can we apply for loan forgiveness under the Paycheck Protection Act? Montan... Read more
Find Form 3508S for PPP Loan Forgiveness
Question: How can we apply for loan forgiveness under the Paycheck Protection Act? Montan... Read more
COVID-19:
Recap SARS-CoV-2 Lab Coding Options
3 categories get you to the right code. We've kept you abreast of nearly 25 new lab proc... Read more
Recap SARS-CoV-2 Lab Coding Options
3 categories get you to the right code. We've kept you abreast of nearly 25 new lab proc... Read more
CD-10-CM:
Translate Pathology Report Lingo to Colon Polyp Dx Code
Don't let neoplastic diagnoses stump you. When your pathologist reports colon polyp findi... Read more
Translate Pathology Report Lingo to Colon Polyp Dx Code
Don't let neoplastic diagnoses stump you. When your pathologist reports colon polyp findi... Read more
HIPAA:
Use This Remote Work Toolkit During Pandemic
Keep up security at home. With more staff working from home during the COVID-19 pandemic,... Read more
Use This Remote Work Toolkit During Pandemic
Keep up security at home. With more staff working from home during the COVID-19 pandemic,... Read more
Reader Questions:
Capture Special Stain Service
Question: The surgeon submitted a lung biopsy for suspected histoplasmosis infection. The ... Read more
Capture Special Stain Service
Question: The surgeon submitted a lung biopsy for suspected histoplasmosis infection. The ... Read more
Reader Questions:
Distinguish Creatin Kinase Tests
Question: A cardiologist client requested total CK and CK isoenzymes upon the patient's ho... Read more
Distinguish Creatin Kinase Tests
Question: A cardiologist client requested total CK and CK isoenzymes upon the patient's ho... Read more
Reader Questions:
Beware Billing Flu Tests Together
Question: Can we bill 87804 and 87502 together? I have added a 59 modifier, but I am still... Read more
Beware Billing Flu Tests Together
Question: Can we bill 87804 and 87502 together? I have added a 59 modifier, but I am still... Read more
Focus Respiratory Pathogen Panels with SARS-CoV-2
Learn test codes with multiple targets. You just mastered coding for lab tests to pinpoin... Read more
Learn test codes with multiple targets. You just mastered coding for lab tests to pinpoin... Read more
You Be the Coder:
Look for Separate Site and Exam
Question: The surgeon submitted two fibroids from different anatomic sites from a patient ... Read more
Look for Separate Site and Exam
Question: The surgeon submitted two fibroids from different anatomic sites from a patient ... Read more
CPT® 2021:
Bring MAAA Updates in Focus
Check Appendix O for more codes. New Multianalyte Assays with Algorithmic Analysis (MAAA)... Read more
Bring MAAA Updates in Focus
Check Appendix O for more codes. New Multianalyte Assays with Algorithmic Analysis (MAAA)... Read more
MPFS Final Rule:
See How Medicare Pay 2021 Impacts Your Lab
Expect conversion factor hardship. CMS released the final 2021 Medicare Physician Fee Sc... Read more
See How Medicare Pay 2021 Impacts Your Lab
Expect conversion factor hardship. CMS released the final 2021 Medicare Physician Fee Sc... Read more
Compliance:
Don’t Miss Unexpected Stark Rule Update
Greet exceptions to foster value-based arrangements. After putting the brakes on an updat... Read more
Don’t Miss Unexpected Stark Rule Update
Greet exceptions to foster value-based arrangements. After putting the brakes on an updat... Read more
You Be the Coder:
Pocket the Prostate Biopsy Difference
Question: Why is there such a huge reimbursement difference for prostate biopsy for Medica... Read more
Pocket the Prostate Biopsy Difference
Question: Why is there such a huge reimbursement difference for prostate biopsy for Medica... Read more
Reader Questions:
Remember Ovarian ‘Functional Activity’
Question: We have a pathology report for a right ovary biopsy with a diagnosis of “invas... Read more
Remember Ovarian ‘Functional Activity’
Question: We have a pathology report for a right ovary biopsy with a diagnosis of “invas... Read more
Reader Questions:
Take Care of e-Signature Security
Question: A recent compliance risk assessment determined that the e-signatures we use and ... Read more
Take Care of e-Signature Security
Question: A recent compliance risk assessment determined that the e-signatures we use and ... Read more
Reader Questions:
Find New Epilepsy GSP Code
Question: I've heard there is a new “epilepsy panel” that targets gene mutations to he... Read more
Find New Epilepsy GSP Code
Question: I've heard there is a new “epilepsy panel” that targets gene mutations to he... Read more
CPT® 2021:
Accommodate New Drug-Test Codes
Untangle multiple codes for single analyte. With 10 new therapeutic drug assay codes and ... Read more
Accommodate New Drug-Test Codes
Untangle multiple codes for single analyte. With 10 new therapeutic drug assay codes and ... Read more
CPT® 2021:
Keep Current With This Molecular Pathology Coding Update
Check out Tier 2 to Tier 1 conversions. CPT® 2021 introduces 16 new Tier 1 molecular pat... Read more
Keep Current With This Molecular Pathology Coding Update
Check out Tier 2 to Tier 1 conversions. CPT® 2021 introduces 16 new Tier 1 molecular pat... Read more
HIPAA:
PHI is More Than the Patient Chart
Hedge compliance obligations during PHE. Although your lab has some leeway for sharing pr... Read more
PHI is More Than the Patient Chart
Hedge compliance obligations during PHE. Although your lab has some leeway for sharing pr... Read more
You Be the Coder:
Capture Full Nail Exam Services
Question: Our pathologist examined a skin and toenail excision specimen to rule out suspec... Read more
Capture Full Nail Exam Services
Question: Our pathologist examined a skin and toenail excision specimen to rule out suspec... Read more
Reader Questions:
Identify Separate Mohs from Frozen Sections
Question: We have a dermatology clinic client for whom we occasionally examine frozen sect... Read more
Identify Separate Mohs from Frozen Sections
Question: We have a dermatology clinic client for whom we occasionally examine frozen sect... Read more
Reader Questions:
Use These Scam Protection Tips
Question: What's the difference between phishing and vishing, and how can we protect ourse... Read more
Use These Scam Protection Tips
Question: What's the difference between phishing and vishing, and how can we protect ourse... Read more
Reader Questions:
Learn New Respiratory Virus Code
Question: Our lab performs an antigen immunoassay test for SARS-CoV-2 plus influenza ... Read more
Learn New Respiratory Virus Code
Question: Our lab performs an antigen immunoassay test for SARS-CoV-2 plus influenza ... Read more
Reader Questions:
Know Data Elements for Eligibility
Question: We're trying to verify a Medicare beneficiary's eligibility with our MAC using a... Read more
Know Data Elements for Eligibility
Question: We're trying to verify a Medicare beneficiary's eligibility with our MAC using a... Read more