Latest Medical Coding Guidelines For Pathology 2024

The branch of medical science that is focused on the diagnoses and study of diseases. There are several medical codes used for pathology billing services. These pathology codes are also used in other areas where clinical information is required. 

CPT pathology codes are used to identify the cause of a patient’s medical condition. These medical codes are used to determine the cost of services and procedures in pathology medical billing. 

Medical billing and coding services enable healthcare providers to get payments and reimbursements from patients and insurance companies. It is an essential component of the healthcare industry, which helps providers save time, money, and effort by providing a comprehensive solution to all your payment-related problems. 

In this article, we’ll discuss what are the latest pathology billing and coding guidelines, what is there significance, and how we assist you pathologists with practice management processes. 

What are CPT codes?

Introduced by the American Medical Association (AMA), CPT codes stand for Current Procedural Terminology codes which are used to document medical procedures into universal alpha-numeric codes to streamline reporting, increase accuracy, and ensure efficiency. 

What Is The Role Of CPT Pathology Codes In Medical Billing?

CPT code is an internationally recognized coding system. It provides uniformity across healthcare facilities and medical care providers. It allows you to compare costs between different medical procedures quickly. Moreover, it allows everyone to compare costs based on different medical procedures and pathology tests on different geographical locations or other factors including; type/ timing of service delivery (e.g. emergency vs non-emergency care). 

The CPT coding system is widely accepted medical nomenclature that is used to report medical procedures and services for the following tasks; 

• Process claims
• Conduct research
• Evaluate healthcare utilization
• Develop medical guidelines and other forms of healthcare documentation

What Is The Significance Of Pathology?

Pathology involves diagnoses of infections and pathologies of human body organs. Pathologists are physicians who specialize in pathology and help in the diagnosis of human diseases. They diagnose diseases by testing tissue samples to identify the signs of illness/injury. 

Pathologists also use laboratory technologies such as microscopes, blood tests, and DNA analysis to diagnose diseases. These techniques are used to investigate these conditions further. 

What Are The Different Types of Pathological Labs? 

There are several different types of pathology labs such as;

• Histopathology: It deals with the study of tissue samples from a patient’s body to investigate any signs of disease/ abormality. 

• Microbiology laboratory: A lab where doctors perform tests on bacteria or microbes to determine if there is an infection present in your body. These tests are used to diagnose certain diseases like tuberculosis (TB). 

• Molecular genetics laboratory: A lab where doctors test DNA to determine if a genetic mutation exists in your body. These tests are often used to diagnose certain diseases such as cancer or Down syndrome. 

Molecular genetics labs either work privately or are associated with a hospital. 

• Histopathology laboratory: A medical facility where doctors take samples from your body. They examine these samples under a microscope to investigate any sign of cancer. Providers take sample tissues for testing during surgery or biopsies. 

• Cytology laboratory: A medical facility where doctors take samples from your body and examine them under a microscope to check for any infection indications. This testing can be done on swabs that are taken during an examination or biopsy. 

Who Are Pathologists? 

Medical professionals who study the diagnosis of diseases are called pathologists. A pathologist is responsible for studying tissue from patients and making a diagnosis based on what they find. Pathology is the subspecialty of the medical field. Pathologists may be qualified and certified in anatomic, clinical, or forensic pathology. 

What Are The Different Types of Pathology Services? 

Pathology services are an integral part of the healthcare industry. It involves microscopic examination of cells and tissues to diagnose diseases and conditions. 

Pathology services include microscopic examination of cells, tissues, organs, and body fluids. It also includes other molecular diagnostics i.e. genetic testing. 

Why Are CPT Codes Used In Pathology?

The American Medical Association (AMA) updates and maintains the CPT codes (10-digit numbers used by medical professionals to describe their services). The CPT codes allow healthcare providers and patients to know about the medical care services they’re getting so that both parties can be billed correctly. 

CPT codes were developed so everyone would understand what was being billed for. Moreover, pathology codes are developed to set a billing standard between both the parties i.e. healthcare providers and patients. Also, these medical codes describe the cost of every medical treatment, diagnosis and E/M (evaluation and management) service and let the insurance companies know how much they should pay out. 

What Is The History of CPT Codes? 

Centers for Medicare and Medicaid Services (CMS) introduced medical codes in 1969. These medical code sets are revised and updated every year. However, their purpose is still as same as it was in the beginning i.e. to describe the patient’s conditions and treatments. 

CPT stands for Current Procedural Terminology and it is a standardized set if medical codes used in the medical field. Healthcare providers use CPT codes to document health information about patient-physician encounters. 

The first edition of CPT codes was published in 1983. It included only 4 major body systems i.e. Cardiovascular Disease (CV), Diabetes Mellitus (DM), and respiratory system disorders (RSD). It also consisted of some other diseases such as neoplasms. 

Why are CPT Codes used in Pathology?

The purpose of CPT codes in the field of pathology includes; providing a standard way of describing the pathology services. It helps medical providers to make sure that they’ve used accurate codes to describe their services for billing and reimbursement purposes. 

How are Pathology Medical Billing Services Changing?

There are many reasons that cause updates, modifications and changes in CPT over the course of time. The major reasons for changes in CPT codes are the new diseases, the ever-changing environment of the healthcare industry, and the innovative technologies used for pathology services and diagnosis. 

Therefore, pathologists should comply with the changes in CPT codes and make sure to adopt contemporary measures for pathology medical billing services. It helps pathologists to streamline their billing services 

Healthcare providers are becoming more aware of the cost savings and efficiency benefits of pathology medical billing services. Moreover, it is important to streamline pathology billing services to improve patient’s medical care experience. It also assists hospitals to reduce their costs by eliminating unnecessary testing or procedures that are not required for the treatment. 

This initiative will also help healthcare providers to reduce their costs even more as time goes on which means it’s important for pathologists to make sure they’re using all available resources when it comes to deliver best quality patient care services. 

Pathology and Laboratory Coding Guidelines 2024 

The pathology and laboratory coding guidelines are rules for laboratory medical billing services. These guidelines provide an overview of what information is required to report a medical issue. It also information on how it should be used in medical bills. It also provides a standard for the formatting of medical claims and directions for pathology billing services.  

Pathologists should use the CPT codes to submit medical claims to insurance companies. They should use these medical codes to prepare and submit medical bills to government agencies (Medicare and Medicaid). 

The medical codes are uniform and standardized across all healthcare practices. However, these medical codes vary from one provider to another based on specific procedures. A doctor or specialist will perform such procedures during an appointment or procedure session. Moreover, there are some rules and regulations in the healthcare industry that are also specific and applicable in some specific states in the US. 

Pathology CPT Codes 2024

The pathology codes are also called the Code of Medical Practices (CMP) code 2024. It is used in medical billing to identify the service type provided. For example, it is listed after a patient’s name and medical insurance information on an invoice. It can also be listed on other documents e.g. CPT codes for lab tests 2024 are as follows; 

88104:  Cytopathology, fluids, washings, or brushings, except cervical or vaginal; smears with interpretation.

88106:  Cytopathology, fluids, washings, or brushings, except cervical or vaginal; filter method only with interpretation.

88107:  Cytopathology, fluids, washings, or brushings, except cervical or vaginal; smears and filter preparation with interpretation

88108: Cytopathology, concentration technique, smears, and interpretation (e.g., Saccomanno technique) (For the performance of smear, use 88104; for cell block interpretation, use 88305.)

88125: Cytopathology, forensic (e.g., sperm) 88130 Sex chromatin identification; Barr bodies.

88140: Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks. 

88365: CPT code description 

88365: Tissue in-situ hybridization, interpretation, and report.

Categories of Surgical Pathology CPT codes

This list of CPT codes for lab tests is a combination of two categories:

1) gross and microscopic examination. It is further divided into six levels. Each level has a particular set of specimens.

2) service code (e.g., cytopathology and pathology).

CPT 88300 – Surgical Pathology level 1 Gross Examination only

Any specimen investigating pathologists think may be appropriately diagnosed “without” microscopic investigation is given the service code 88300. CPT 88330 is used to report a pathology level 1 gross examination.

The code will be added when you have completed the first phase of your work on the case or if you need a second opinion on it. This code can also be used in conjunction with other regulations, such as CPT 88302 or CPT 88309.

CPT 88302 – Surgical Pathology, Gross and Microscopic Examination of Specimen

CPT pathology codes 88302 is a level 2 code. The specimen is revived grossly and also under a microscope. It describes reviewing a slide that has already been scanned at a lower level. It provides more detail on the findings of that previous level. Different organs can be viewed at this level. For example, a Hernia sac in any location, hydrocele sac, nerve skin, plastic repair, sympathetic ganglion, etc.

CPT 88304 – Surgical Pathology level 3 Complex Microscopic and Report 

The CPT 88304 code is used for clinical pathology services. The result of this code will be sent in a report, which can be used to help diagnose and treat patients. In addition, this level is used for the diagnosis of different structures. For example, hematoma, hemorrhoids, hydatid of Morgagni, intervertebral disc, joint, loose Body, meniscus, mucocele, salivary neuroma, Morton’s/Traumatic Pilonidal Cyst/Sinus, etc.

CPT 88305 – Surgical Pathology level 4 Gross, Microscopic, and Special Stains

CPT 88315, also known as level 4 pathology. In these services, a specialist/consultant is required to review the gross and microscopic examination of the specimen. This code indicates that you need a pathologist on site. He can help interpret your tissue samples. He can also make recommendations about treatment options for your patient. The specimens for this level are cervix biopsy, colon biopsy, duodenum biopsy, endocervix curetting/biopsy, endometrium curetting/biopsy, esophagus biopsy, extremity amputation/ traumatic, etc.

CPT 88307 – Surgical Pathology level 5 Gross and Microscopic Examination  

CPT pathology codes 88307 are used for gross and microscopic examination of specimens. Some specimens of this level are myocardium biopsy, odontogenic tumor, salivary gland, sentinel lymph node, etc.

You can find the pathology CPT codes pdf from this link (http://a2.mayomedicallaboratories.com/webjc/attachments/53/05c49d7-surgical-pathology.pdf).

Benefits of Pathology Billing Services They provide various services like:

revenue cycle management. 
eligibility verification. 
claim submission. 
denial management.
handling worker’s compensation claims.
creating reports to track billable hours by physician or procedure type.
maintaining accounts receivable status reports by an insurance company or patient).
generating patient statements.
collections report (aging report) showing the amount owed by the patient).
Enforcing compliance with your company’s procedures and policies.
Ensuring that your insurer receives all necessary documentation.
comply with government regulations involving health care laws such as HIPAA.
What is the Role of a Medical Billing Company in Billing?

Pathology medical billing services are an administrative support function that helps pathologists with their daily practice and patient involvement. It also handles the payment for pathology labs, hospitals, and clinics.

The main job of a pathology medical billing company is to ensure that all bills are paid on time by collecting payments from clients or Medicare/Medicaid programs. They also provide backup support when needed in case there are any issues during the collection or processing of payments.

The primary function of a medical billing service is to prepare claims and invoices (coding) for insurance companies. As a result, they can reimburse a doctor or hospital for services rendered.

The process starts with an intake, where the patient submits their information and asks the doctor’s office to submit the claim. Then, after approving all documentation related to diagnosis/treatment plans, the claim submission was sent off electronically via email. Then, the doctor finally gets reimbursement after verification of all documents. 

Conclusion: 

It is an overview of the mainly used CPT pathology codes. There are many more, which will be discussed in future sections. But this post should give you an idea of how familiar pathologists use these codes. U Control Billing provides the best solution to your needs in pathology medical billing. Our services will also assist you in every part of your medical billing.