Psychology Problems Advice Info

Pathology Coding: Get Around the Limitations and Hiccups  

Article by Julia Rose

Pathology coding involves a working around a lot of sub-specialties like neuropathology, hematopathology, dermatopathology, renal pathology, and clinical pathology. You will often come across many controversial CPT coding scenarios, and it’s tough to decide the charge policy to defend your decision, and finally the reimbursement. The CCI edits, however, make pathology consultations mutually exclusive from most lab tests, excluding certain exceptions that allow you to overrule the edits and get some extra dollars. According to the CPT manual, a clinical pathology consultation is a service, including a written report, rendered by the pathologist in response to a request from an attending physician in relation to a test result requiring additional medical interpretive judgment. Reporting of a test result without medical interpretive judgment is not considered a clinical pathology consultation. The edits designate 80500 and 80502 as unallowable with the primary clinical laboratory test code in the case of: * all 18 lab tests approved by Medicare for pathologist interpretation of clinical lab tests, listed in Section 15020-E of the Medicare Carriers Manual * some lab panels, e.g. 80061, lipid panel * evocative/suppression testing, codes 80400-80440 * select chemistry codes, e.g. blood gases, codes 82803-82820, fetal lung maturity tests, codes 83661-83664 and molecular diagnostics, codes 83890-83912* many hematology and coagulation codes, 85002-85999 * many immunology codes in the range 86000-86384 * certain microbiology codes, 87001-87999, including immunofluorescent techniques codes 87260-87300, nucleic-acid probes, codes 87470-87799, and direct optical observation techniques, codes 87810-87899 for infectious agent antigen detection* some cytogenetic studies, 88230-88299 Medicare, however, doesn’t ban the use of consultation codes in pathology coding from being used with the above codes in all circumstances. Labs may bill the consultation codes using a modifier if the situation meets these criteria:

* The patient’s attending physician requests the interpretation. * The interpretation is documented by a written narrative report included in the patient’s medical record. * The interpretation requires the exercise of medical judgment by the pathologist. * The lab test result must be outside the clinically significant normal or expected range in view of the patient’s condition.

At an independent laboratory, both clinical lab tests and consultations are billed together. In the independent lab setting, modifier -59 must be used to override the CCI edit pair whenever a pathologist performs a clinical consultation for a lab test that is bundled with 80500 or 80502. Medicare’s national CCI edits are designed in part to detect instances when a laboratory or other health care provider is unbundling charges, meaning that two or more integral components of a single service are separately billed. Pathology coding has its own complications and limitations, but with proper guidance you can maintain compliance and get your office the reimbursement it deserves. New additions and changes come up to ease conflicting scenarios, while some updates are crucial, especially when they refer to some coding practices which can’t be followed any more. To get the latest know-hows from industry experts, you can attend conferences, or simply order CDs or MP3s on pathology coding conferences.

About the Author

We also provide medical billing and medical coding audio conferences with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.