Molecular Pathology

Meg

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1
Location
Murphy, NC
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Hello. We are going to start coding Molecular Pathology. I don't even know where to start. Anybody have some helpful hints? Pointers? Web sites where I can learn? Any and all information would be appreciated.

Thanks
Meg
 

danachock

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214
Location
Brainerd, MN
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Hi Meg,
Are these charges a send out to another facility or will they be performed "in house"? When I'm faced with claim rejections, help with denials, or an MUE (medical unlikely edits) for charges I will reach out and review our laboratory catalog for the specifics. If I know that a specimen was a send out to another facility - I will refer to their laboratory catalog on their specifics on what we are expected to bill the patient for those services. Sometimes this can be cumbersome especially with any reflex testing.
Many of our send outs are "client billed", so we send it out - they process it and send us the results along with the charges they are billing for that testing. We then pass those charges onto the patient. I'm unsure how your facility has this set up, but with the ability to review your catalog or even an alternative laboratory catalog (if this was a send out) to anticipated which charges may or may not be billed is certainly a start.
Also when billing the majority of these procedures, please take the time to add the necessary procedure description upfront before the claim is actually sent out versus dealing with a denial on the back end. I wish I had more to provide to you but wanted to share how I review those charges for reimbursement. Several of those tests bill the same CPT procedure code so it is important to identify what is actually being tested for reimbursement.
Again, many of these tests are super expensive. Make sure your team is receiving those prior authorizations before testing occurs or receiving a valid ABN so your facility isn't simply stuck writing off testing that isn't deemed for meeting "medical necessity".
Hopefully this will at minimum provide a few options for opening doors for research and additional information.
Thanks for listening & have a great evening!
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
 
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