Wiki New to Pathology Billing

[jacquirose]

Hi all! I have just started working with a Pathology client here in my billing office. This will be a new experience for me and I was hoping some of you seasoned billers/coders could offer some advice or knowledge in Pathology coding/billing. My client is located in NJ.

I'm most concerned about needing authorizations for specific codes. We do not do any genetic testing. Are there any codes that would require an auth?

Thank you in advance for your insight!

 

[bbooks]

Hi Jackie. Welcome! I was a brand new coder starting in pathology just two years ago. I code surgical path, Paps that require a pathologist's interpretation, non-gyn cytology, and the tests we send out to specialty labs.

In my work, that I know of, I've not come across anything that requires authorization unless it was something the patient had perhaps already received authorization from their insurance company. Others may be more knowledgeable than me, but I think any authorization is dependent upon the patient's insurance.

What I have seen is that insurance may be very particular about the right diagnosis code to accompany a CPT code, and if the diagnosis code is not correct, they will deny a claim. We have had to resubmit a claim for this reason on occasion.

Most insurance companies and Medicare have their medical policies available on the Internet and they will include a list of diagnosis codes that are accepted for a particular procedure or test.

I hope that's helpful.