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Here are the common CPT code updates effective as of 2023.

CPT Coding Guidelines for Laboratories

CPT® 2023 includes a set of 225 new codes, 93 revised codes, and 75 deleted codes. There are new guidelines introduced for the application of updated CPT lab medical billing codes for every section except anaesthesia. The most significant changes are to the evaluation and management (E/M), percutaneous pulmonary artery revascularization, hernia repairs, lab and pathology, and COVID-19 vaccination codes.

Also added are two new appendices for artificial intelligence (AI) taxonomy (Appendix S) and synchronous real-time interactive audio-only telemedicine services (Appendix T). Here are the highlights of the changes by section, all of which are effective as of 1 Jan 2023.

CPT Codes often used

88300 to 88332: CPT codes for dermatologists
Dermatologists use this CPT code range for pathology. However, there are some specific billing rules that are applied to dermatologists for pathology.

  • When a dermatology practice sends tissue specimens to an outside reference lab that performs technical and professional services (referred to as the global service) and they send bills to the insurance company directly then there is no “pass-through” billing (it means that the dermatology practice has bought these services from the pathology lab at a discounted price). This means that the dermatologist has marked up the cost of the service, and then passed the increased charge on to the patient or insurer carrier through direct billing from the practice.
  • The other way a dermatology practice can charge for pathology lab tests is through Pass-through billing. In this case, the practitioner makes money by purchasing the technical component, or both. The practice marks up the cost of the purchased
  1. No billing for pathology services. In this scenario, the practice sends tissue specimens to an outside reference lab that performs both the technical and professional services (referred to as the global service) and bills the insurance carriers or patients directly. In this scenario, there is no “pass-through” billing. Pass-through billing means that the dermatology practice buys the service(s) from a lab at a discounted price, marks up the cost of the service(s), and then passes the increased charge on to the patient or insurance carrier through direct billing from the practice.
  2. Pass-through billing. Here, the practice makes money by purchasing the technical component, the professional component, or both. The practice marks up the cost of the purchased service and passes the increase on to the patient or insurance company by billing the pathology service(s) directly to the insurance company. Some carriers are now establishing policies that prohibit practices from pass-through billing. Some states have anti-mark up legislation in effect prohibiting physicians from making money by marking up purchased laboratory and/or pathology service. Medicare does not allow pass-through billing.

Following are the most common dermatopathology

Level III - Surgical pathology, gross and microscopic examination. • Abscess • Anus, Tag • Bartholin’s Gland/Cyst • Cartilage, Shavings • Conjunctiva-biopsy/Pterygium • Hematoma • Pilonidal Cyst, Sinus • Skin, Cyst/Tag/Debridement • Soft Tissue, Debridement • Soft Tissue, Lipoma • Vein, Varicosity.
88305: Level IV - Surgical pathology, gross and microscopic examination. • Lip, Biopsy/Wedge Resection • Skin, other than Cyst/Tag/Debridement • Soft tissue, other than Tumour/Mass/Lipoma/Debridement • Tongue Biopsy. The Modifiers TC — Technical Component. (This refers to the technical component of the pathology service that involves the preparation of the slide. This service is usually performed by a technician.)
88304 Level III: Used for level III pathology services like hematoma, anus, abscess.
88305: Used for level IV of the pathology or any microscopic examination, for example, skin, lip, tongue, etc.

For most medical care, you bill a current procedural terminology (CPT) code based on the service. For example, you would use CPT code 36415 for a blood draw or code 99385 for a well-woman visit for a new patient ages 18-39.

But mental health visits can vary in the amount of time they take, which means the mental health billing codes vary, too. After a visit, you’ll bill the code that’s closest with the amount of time you spent with the patient. For example:

90832: 30 minutes of individual psychotherapy (fits for sessions 16-37 minutes)
90834: 45 minutes of individual psychotherapy (fits for sessions 38-52 minutes)
90837: 60 minutes of individual psychotherapy (fits for sessions 53+ minutes)
90846: 50 minutes of family psychotherapy without the patient/client (fits for sessions 26+ minutes)
90847: 50 minutes of family psychotherapy with the patient/client (fits for sessions 26+ minutes)

New CPT codes have been added

80081: Obstetric panel examination, including testing for HIV
81170, 81162, 81218, 81219, 81272, 81273, 81276, 81311, 81314: Genome, gene-specific, and molecular pathology procedures.
81228, 81229, 81405, 81406: Analyses of Cytogenomic microarray
81280, 81282: Analyses of long QT syndrome gene
81412, 81432, 81433, 81434, 81437, 81438, 81442: Different Molecular Multianalyte Assays and procedures for genomic sequencing
81490, 81493, 81525, 81528, 81535, +81536, 81538, 81540, 81545, 81595, 0009M, 0010M: MAAAs that have Multianalyte Assays

Revised CPT Codes

81210, 81275, 81355, 81401, 81402, 81403, 81404, 81405, 81406: Molecular Pathology
81435, 81436, 81445, 81450, 81455: Different Molecular Multianalyte Assays and Procedures for Genomic Sequencing
82542, 83789: Chemistry
86708, 86709: Immunology
87301, 87305, 87320, 87324, 87327, 87328, 87329, 87332, 87335, 87336, 87337, 87338, 87339, 87340, 87341, 87350, 87380, 87385, 87389, 87390, 87391, 87400, 87420, 87425, 87427, 87430, 87449, 87450, 87451, 87502, +87503: Microbiology
88346: Surgical Pathology

The pathology coder must use the correct modifier along with the CPT codes. There are at least nine different modifiers that one must be aware of.

General CPT Changes:

List the appropriate Current Procedural Terminology (CPT) code for the services performed, including any necessary modifiers and appropriate quantities in the days/units field.

Modifiers direct prompt and correct payment of the claims submitted. Documentation modifiers must be billed in the first modifier field.

Modifier "-91" indicates repeat clinical diagnostic laboratory test.

Modifier "-LR" indicates round trip travel.

Modifier "-90" Referred Laboratory Services (refer to C).

When reporting the patient's diagnosis or condition with an ICD-10 code. The ICD-10 code should be coded to the highest level of specificity, listing the primary condition in the first position in Item 21 on Form CMS-1500 or the electronic equivalent. Claims not coded to the greatest degree of accuracy and digit level completeness will be denied as unprocessable.

It is understood that any diagnosis information submitted must have medical justification for the procedure (in the patient record). Subsequent determination that the medical record is lacking such justification will result in a retroactive denial under Section 1862(a)(1)(A).

Clinical Laboratory Improvement Act (CLIA)

CLIA numbers are required on claims (paper and electronic) for any laboratory performing CLIA covered procedures. Otherwise, the claim will be rejected as an unprocessable claim.

The 10-digit CLIA certification number must be placed in Item 23 of the CMS-1500 form or the electronic equivalent.

Medical Coding Guidelines For Laboratory

Pathology laboratories are vital in any medical practice as a unique medical field establishment. However, this kind of establishment can vary in iterations and size and, at times, can be part of the hospital. Most laboratories are established near hospitals or medical practice facilities, given the work it does. While hospital labs generate only 3 to 5 percent of hospital revenue, their findings make up 70 to 80 percent of a patient’s electronic health record (EHR). Furthermore, the CDC estimated that almost 70 percent of doctors’ medical decisions are based on lab test results.

This means careful attention needs to be given to improving the revenue process of a pathology lab so that it can invest in the latest testing technology, other lab resources, and staffing so the patient outcome is better. But all these steps begin with proper coding for the pathology tests done, correct Pathology lab billing, on-time claim submission, and minimising the denials so that patient outcome is better.

Important Points to Remember:

The process of pathology coding and adding the modifiers is complex as the coders need to understand the different tests that can qualify under each modifier. For instance, they must know about the tests that can be identified under the modifiers. They must be eloquent with the HCPC codes often used when sample transportation and specialised equipment are used for pathology laboratory tests.

Lack of proper use of pathology codes would mean a loss in revenue for the pathology labs, which will eventually affect the entire system. The only way to ensure that the pathology laboratory service can give the best results is by taking care of their pathology coding and billing system and getting the help of a specialised pathology lab coding and billing company.

How Does Adhering to the Coding Guidelines Help?

Are you wondering which pathology coding and billing company adhere to the pathology laboratory billing and coding guidelines? It is the 24/7 Medical Billing Services. They have a team of pathology laboratory billing and coding experts who know the latest codes and modifiers and the constant updates and changes made in the rules and regulations of coding created by the governing bodies, Medicare, Medicaid, and insurance companies.

With the help of an expert pathology coding and billing partner like 24/7 Medical Billing Services that maintains the coding guidelines, you can quickly grow your lab with uninterrupted revenue flows. These are the few simple ways by which the 24/7 Medical Billing Services can improve the revenue of any pathology lab practice with its billing and coding services:

Decrease in Operational Costs

Keeping a separate coding and billing department in any pathology lab is vital since the laboratory staff is busy with pathological procedures. This means the establishment must invest in pathology billing and coding software and give training with the latest software updates, coding guidelines, and regulation changes in the billing and coding protocols. All these and the other overhead costs can be cut down with an increase in the cash flows by partnering with 24/7 Medical Billing Services.

No More Errors in Pathology Coding and Billing

With dedicated outsourced pathology laboratory staff equipped with the coding guidelines and the latest software, coding errors can be minimised with the assurance of correct and accurate pathology billing. Also, timely submission of clean claims with regular follow-ups can be guaranteed with further no loss of revenues for the pathology labs.

Enhanced Processing

There is often revenue loss, and claims are denied because of improper eligibility verification and wrong coding. The outsourced pathology coding partner can do the verification while you take care of your patient’s tests. Also, 24/7 Medical Billing Services uses the latest pathology lab billing software to accurately process billing and coding. It allows the entire process to be done quicker, which means the payment process is faster with 100% reimbursements.

It is time to understand pathology labs' coding and billing process and increase the service’s revenue in no time with the help of an outsourcing pathology coding and billing partner like 24/7 Medical Billing Services.

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