Pathology/Lab Coding Alert

Performing pathology services from afar using telecommunications and computer systems may be the wave of the future, but who's paying and how? Because pathology services do not require "face-to-face" time with the patient, Medicare payment for telepathology is way ahead of many other telehealth services and is not subject to the same restrictions. Pathologists use "static" telepathology for consultations on images referred from distant sites, and some are beginning to use "dynamic" telepathology for real-time interpretation of frozen sections while the patient is in surgery at a remote location. Although issues such as licensure, confidentiality and liability are not fully resolved, Medicare and other insurers have had a history of paying for telepathology services. Payers typically cover telepathology as they would the same diagnostic services without the use of telecommunications transmissions. Even so, "always check with your insurer to be certain of coverage," says Yukako Yagi, MD, director of telepathology at the University of Pittsburgh Medical Center. Use Consultation, Frozen Section Codes Report telepathology using the same codes you would use for the conventional service, according to Yagi and a CMS spokesman. The same coverage rules apply, such as supervision and medical necessity requirements, and the payment amounts are the same, according to the CMS source. A local Medicare carrier, however, may deny a specific telepathology service if, for example, the carrier considers it investigational.

"For a pathology consultation on slides viewed via telepathology, report 88321 (Consultation and report on referred slides prepared elsewhere)," says Gail Barker, MBA, pathology department administrator and associate director of finance for telemedicine at the University of Arizona Health Sciences Center in Tucson. The pathologist performs this service when a physician from the other site requests it, and the pathologist provides a consultation and reports on the findings. The code description does not distinguish how the pathologist views the slides, whether in person or via the computer.

"In some cases we report telepathology consultations using 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material)," Barker says. Only use this code if the pathologist provides a review of the complete patient record, not just the pathology reports submitted with the current telepathology request. Report frozen sections via telepathology just as you would report the conventional service, Yagi says. Use 88331 (Pathology consultation during surgery; first tissue block, with frozen section[s], single specimen) and 88332 ( each additional tissue block with frozen section[s]). Because the originating lab prepares the frozen sections, that lab should bill the technical component of the service using modifier -TC (Technical component), and the off-site pathologist who interprets the frozen sections should bill for the professional component using modifier -26 [...]