pathology

  1. M

    Wiki Humana Mcr Diagnosis code issue

    When billing colonscopies/egds for our practice-physician orders colonoscopy for positive cologard (r19.5) pathology comes back nothing found. We obviously leave r19.5. Humana pays procedure but denies pathology for dx code issue. Why? We have never had issues with this. Physician orders egd for...
  2. M

    Wiki BCBS Denying Pathology Claims

    Has anyone been having issues with BCBS denying pathology claims since maybe June/July of 2024? We have denials and all they can say is since Avalon take over there are new guidelines- things such as k29.50, k21.00, and k22.89 cannot be coded together. Or k22.2 and k21.9 cannot be coded...
  3. B

    Wiki Pathology

    These are the denial reasons from BCBS KC and BCBS OOS and all are for CPT 88305. There are 3 different denial reasons depending on where you look. All the claims are from July. This denial is what is on the BCBS website for claims, "Procedure is inappropriate for patient age" This denial is...
  4. T

    Wiki Splitting Codes with Modifiers

    I need some advice, hoping someone can help me with this scenario. My billing company is using an outside company to code all the charges. On our additional testing for organisms causing diarrhea, we are looking for 1. Anti-gliadin, fecal ELISA 2. Anti-TTG, fecal by ELISA 3. Bile Acids, fecal by...
  5. S

    Wiki PQRS

    Good Morning, My provider has a patient who's pathology came back severely atypical and stated "cannot rule our early evolving melanoma". We of course are going to clinically treat this as a melanoma but I'm wondering in regard to PQRS, do I still complete those steps? Thanks in advance
  6. B

    Wiki 88108

    Going back and forth with the pathology clinic on the charges for 88108 vs 88104 vs 80503/504. Smear Review Interpretation - Reactive mesothelial cells, Mixed inflammatory cells Gross Description: Stained cytospins preperations (2x) received for review. Consulting Pathologist...
  7. B

    Wiki gross exam with pus or other tissue

    I have a pathologist who is asking the following question: Normally a gross only has a code 88300 However, sometimes tissue is adherent with pus or other benign tissue She's wondering if she should use 88302 or 88304
  8. L

    Wiki FNA/FNAB - Can you bill 88173 and 88305 if no cell block was created but tissue was submitted

    Hi there! I have a pathology coding question that I'm hoping you can help get answered. Can you bill an 88305 and an 88172 if a cell block wasn't created but tissue was submitted for microscopic examination? Some believe you cannot bill for cytologic and surgical pathology CPT codes on the...
  9. C

    Wiki Laboratory Billing

    I'm having a difficult time finding the CMS rule stating a clinician's office cannot bill the entirety of a lab procedure when part of that procedure was performed at an independent lab. Is this something I've remembered incorrectly or am I thinking too hard? Can someone please help?
  10. S

    Wiki Pathology Dx Coding

    We use a pathology requisition that has a place for a diagnosis and a place for the provider to add pertinent clinical information/indications/history. The problem we are having is that the ordering provider will fill out the clinical information and not provide a diagnosis in the Dx space...
  11. J

    Wiki Pathology coding - remote

    If there are any experienced pathology coders looking for a great coding job - check the link! https://uwhires.admin.washington.edu/eng/candidates/default.cfm?szCategory=jobprofile&szOrderID=168056&szCandidateID=0&szSearchWords=pathology&szReturnToSearch=1
  12. A

    Wiki Coding special stains 88312 & 88313

    I am trying to resolve a conflict between a client and other coders regarding the billing of special stains 88312 & 88313. What is the proper coding for the following? Is it 88313 X 2 or 88313 X 8, 88313-59 X 6? Movat stains (A4, A6, A8-A9, B3-B5, B7-B10, B23-B14) were performed for the...
  13. R

    Wiki Pricing Pathology

    Posting this for a friend: I was diagnosed about a year ago with what is called Benign Leucopenia (basically low white blood count). But the Hematologist wants to try to eliminate any possibilities so he can treat me accordingly. He wants to run a Bone Marrow Biopsy to see what is going on...
  14. A

    Wiki Specimen Reading after Patient Death

    According to CMS guidelines we bill with for a date of service that the specimen is read and signed by the pathologist. I have a specimen that was looked at the day following the death of a patient. CMS is telling me there is a HCPCS modifier specific to this situation but I have not been...
  15. L

    Wiki Looking for Guidance for CGx billing for FCSO (Florida Medicare)

    Hi, I recently received denials for upper tier moldx codes because I billed two units per line. I had someone call a rep and the rep indicated they were denied because we billed more than one unit per line, and advised to only bill one unit per each CPT per line. Most of my experience says...
  16. J

    Wiki Polyp diagnosis from Pathology result

    Hello everyone, I need some help on clarification of diagnosing polyps from the pathology report. When our physicians pull polyps, we hold the claim until the pathology report comes in. We then code the polyp depending on the results. The problem is, there are so many different pathology...
  17. AlyssaM907

    Wiki Uterus weight for hysterectomy

    So I've been trying to find clarification online...but haven't found anything so far. I'm new to OB/GYN coding and have found I have a problem reading a little too much in between the lines and making sure my codes fit EXACTLY. With that being said: On my path report the pathologist states she...
    • AlyssaM907
    • Thread
    • lavh pathology uterus weight
    • Replies: 3
    • Forum: OB/GYN
  18. H

    Wiki Single Tissue - 2 Containers - 1 or 2 specimens?

    Our physicians' group recently started coding/billing pathology services. We have a scenario that keeps getting different answers from different people: A single tissue specimen was taken. The specimen was divided into 2 pieces and put in 2 separate containers. One container sent for gross...
  19. baroquecoder

    Wiki 11606 with 99214

    Patient's chief complaint is 'presents for removal of lesion' HPI: lesion present for 3 months and growing ROS EXAM Lesion removed impression; BCC not sent to pathology not confirmed as BCC Since the patient presented for the sole reason of having the lesion removed, and the procedure was...
  20. S

    Wiki Modifier 26

    I have a question? When billing for pathology services for a procedure that was done in POS 24 are we to apply the modifier 26? Our office is receiving denials when billing for the services with a global. The denial states that the technical component was covered under the facility charges. When...
  21. N

    Wiki PQRS Updates for Pathology

    Hi, I have a doubt regarding PQRS for pathology 2017. Are there any updated version for the following measures? PQRS# 99 100 249 250 251 395 396 397
  22. W

    Wiki Pathology Immunohistochemistry PD-L1 (immunohistochemistry clone 22C3)

    The PD-L1 companion diagnostic test for Keytruda (immunohistochemistry clone 22C3) is interpreted using a Tumor Proportion Score (TPS); however, the result that is rendered is qualitative and the package insert from Dako indicates that this is a “qualitative” test. With this logic, our...
  23. T

    Wiki Shave Lesion and Pathology

    Hello fellow Coders, I am in need of much help. I have struggled with when to bill for a Pathology report code. Are there certain codes that require a Path report to be billed? I am in a Family Practice/OB-Gyn group and they perform shave lesions and excisions. These are sent for Pathology...
  24. N

    Wiki Cpt code globulin

    HI! How will you CPT code GLOBULIN alone term? Thanks in advance for the answers.
  25. M

    Wiki Help! ... Age related loss of the Y chromosome

    Does anyone know ICD-10 code for "Age related loss of the Y chromosome" ? I would appreciate any input...Thanks!
  26. K

    Wiki Billing Consultation code 88329 multiple times

    The provider submitted a surgical pathology report showing that 8 specimens were obtained and examined during a surgical procedure. The provider is billing CPT 88329 a total of 8 times for the same date of service. Is this appropriate?
  27. D

    Wiki When to use postoperative or pathology diagnosis?

    Can anyone tell me where I can find the guidelines or rules for coding a diagnosis from the postoperative diagnosis or the pathology report findings? (such as benign tumors). Through my coursework in AAPC, I have been coding from the pathology report if it gives more specific details about the...
  28. B

    Wiki 88331 vs 88305

    Ok Coding Community. I need your help. My docs, who are Mohs surgeons, do biopsies here in our office and then process them via frozen section. Sometimes the results are available before a patient leaves the office, sometimes they are not. Just depends on how busy the lab is at the time and...
  29. I

    Wiki Billing for Pathology and Labs HELP...

    Example: New PT comes in to practice with chest pain. Problem list is clean, due to PT being new to the practice. Dr. orders a series of blood tests, but has no diagnosis that meet medical necessity. Can the Dr. wait for Lab results to come in, to then assign a diagnosis that does meet medical...
  30. L

    Wiki -TC Portion Pathology in ASC

    I'm new to both pathology and ASC billing. I have billed our -TC portion of the pathology that was done in our ASC. I billed 88305-TC with a POS of 24. I am being denied with Cigna for inconsistent modifier use and an Aetna denial because "treatment has been rendered by the payer to be...
  31. K

    Wiki Coding w/o a pathology

    Patient referred to our oncologist with a solitary pulmonary nodule, no pathology. The physician has entered a cancer diagnosis into the patient's EMR. She states that this is a clinical diagnosis based on her findings and patient history. I have advised her against this in the event that...
    • KMayercsik
    • Thread
    • diagnosis diagnosis coding medical records request pathology patient
    • Replies: 6
    • Forum: Diagnosis Coding
  32. S

    Wiki Breast Bx- Dx code

    When billing for a breast bx, is it best to wait for the pathology report to come back to be able to bill with final dx, or can we bill with the reason the bx was done? Thanks
  33. V

    Wiki 99000/collection fee

    Hello, I have a pathologist who wants to bill a 99000, collection/handling fee when they pick a specimen up from the hospital to take to their lab. Does anyone know if we can do that? Any feedback would be appreciated. Thank you!
  34. P

    Wiki unclear pathology terminology to code excision

    I am coding an excision of lesion on thigh that was on hold for pathology [CPT 12032, 11402]. The path result diagnosis came back as "atypical compound melanocytic nevus". I would code this as dx 216.7 (benign neoplasm, thigh) - however, the pathology states additionally "the findings are...
    • peachygirl
    • Thread
    • ambiguous terminology dermatology excision pathology
    • Replies: 1
    • Forum: Dermatology
  35. L

    Wiki Billing for insufficient quantities to test

    A doctor here sends specimins out to the lab that come back: "insufficient quantity of cells for testing." Can we still bill for the collection (usually cytpathology/papillomavirus)? Can the lab bill for the test?? Thanks Lin CPC
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