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Thread: Medical judgment by the pathologist

  1. #1

    Default Medical judgment by the pathologist

    AAPC: Back to School
    When billing for clinical test interpretations one of the Medicare coverage criteria is the pathologist must exercise medical judgment, and it must express a medical opinion or conclusion. I know the pathologist can't simply say "agree with tech" or "elevated [such and such]" per Dennis Padget. But what if the pathologist interpretation is "all results fall within normal limits" or "electrophorsis of the concentrated urinary protein shows albumin and other fractions present in their usual proportion". Does this meet Medicare's coverage criteria?

  2. #2
    Join Date
    Apr 2007
    New Orleans, LA


    Electrophoresis, and many other pathologic procedures, require an interpretation of the material on hand to meet CPT's criteria rather than a definitive diagnosis. Without viewing the report, your examples seem appropriate, though I would like to see a little more than "WNL."


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