Pathology/Lab Coding Alert

Prepare for 13 specific add-on codes.

When your pathology practice digitizes glass microscope slides for immediate or later pathologic diagnosis, you soon will have a new way to capture the clinical staff work involved in preparing the images.

Read on to see the new codes, learn how to use them for surgical pathology services, and see how the codes fit into CPT^® coding hierarchy.

Greet New Slide Digitization Codes

CPT^® 2023 introduces the following thirteen new codes, effective Jan. 1, 2023, that you’ll need to learn how to use if you bill for surgical pathology services:

• +0751T (Digitization of glass microscope slides for level II, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure))
• +0752T (… for level III, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure))
• +0753T (… for level IV, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure))
• +0754T … for level V, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure))
• +0755T (… for level VI, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure))
• +0756T (… for special stain, including interpretation and report, group I, for microorganisms (eg, acid fast, methenamine silver) (List separately in addition to code for primary procedure))
• +0757T (… for special stain, including interpretation and report, group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry (List separately in addition to code for primary procedure))
• +0758T (… for special stain, including interpretation and report, histochemical stain on frozen tissue block (List separately in addition to code for primary procedure))
• +0759T (… for special stain, including interpretation and report, group III, for enzyme constituents (List separately in addition to code for primary procedure)
• +0760T (… for immunohistochemistry or immunocytochemistry, per specimen, initial single antibody stain procedure (List separately in addition to code for primary procedure))
• +0761T (… for immunohistochemistry or immunocytochemistry, per specimen, each additional single antibody stain procedure (List separately in addition to code for primary procedure))
• +0762T (… for immunohistochemistry or immunocytochemistry, per specimen, each multiplex antibody stain procedure (List separately in addition to code for primary procedure))
• +0763T (… for morphometric analysis, tumor immunohistochemistry (eg, Her-2/ neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure, manual (List separately in addition to code for primary procedure))

Key: You should report one of these new codes only when the slide digitization is used for pathologic diagnosis. The digital images may be used contemporaneously for diagnosis at a remote location or stored using a server or cloud-based digital image archive for later diagnosis.

Avoid reporting the new digitization codes in the following circumstances:

• Don’t use the add-on code if the pathologist uses only direct microscopic glass-slides for surgical pathology evaluation.
• Don’t report one of the slide digitization codes for purposes other than clinical diagnosis, such as archiving, training, tumor boards, algorithm validation, etc.

Value: Glass-slide digitization may allow use of artificial intelligence (AI) algorithms to aid interpretation and diagnosis, and may expand the network of who can view the slides to optimize diagnostic specialization and improve patient outcomes.

Understand Add-On Status

When you see the “+” symbol in front of a code, as you do with each of the 13 new slide digitization codes, you know that you’re dealing with an add-on code.

Key: You should never list an add-on code without also listing a “primary” procedure code. “An add-on code describes additional work associated with a specific primary procedure or service,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Arkansas.

In the case of these 13 new codes, each one describes additional work to digitize microscopic slides prepared for a specific surgical pathology or ancillary procedure.

Primary: CPT^® links each of the new add-on codes to a specific primary procedure based on the code definition and a text note associated with the code. For instance, you should use +0763T only in addition to primary procedure code 88360 (Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; manual). A note following +0763T states “Use +0763T in conjunction with 88360.” Here are the primary service codes for the other new add-on codes:

• The base service codes for add-on codes +0751T through +0755T are surgical pathology examination codes 88302-88309 (Level … - Surgical pathology, gross and microscopic examination …).
• For add-on codes +0756T through +0759T, the primary service is one of the special stain codes 88312-88319 (Special stain including interpretation and report…).
• Add-on codes +0760T through +0763T describe slide digitization in addition to primary immunohistochemistry (IHC) codes 88342-88344 (Immunohistochemistry or immunocytochemistry, per specimen …).

See What Category III Means for Your Lab

CPT^® lists “temporary” codes with four numerals followed by “T” in the Category III section. The purpose of these codes is to allow data collection regarding how often clinicians perform a particular service. That means you should not use an unlisted Category I code if CPT^® provides a Category III code for a procedure — the latter takes priority, according to the section guidelines (You can view the most current code list at www.ama-assn.org/practice-management/cpt/category-iii-codes).

Note: Category III codes have an expiration date, typically after five years. Before expiration, the AMA either converts the procedure to a Category I code or archives the code due to limited use.

Payment: Centers for Medicare and Medicaid Services (CMS) does not assign Relative Value Units (RVUs) to Category III codes. That means there is no established fee schedule for the codes. Individual payers will establish coverage and payment for these codes.

Importance: Regardless of current pay, your lab should use these codes if you perform the described services. “Reporting the Category III codes provides the data for clinical usage that could impact conversion to a Category I code and future payment,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, revenue cycle director for Clinical Health Network for Transformation in Houston, Texas.