Pathology Billing (Lab & Diagnostic Testing)
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An Insight to Pathology Billing Solutions
Pathology labs present all across the U.S are experiencing increased challenges shortage of staff, less reimbursements, boosted costs, and strict regulations, all pose a threat to their financial stability.
Reversing these effects can be achieved by contracting with pathology billing specialists like EZ MedBill. Our all-inclusive RCM services optimize processes and boost revenue results, from precise coding and billing to credentialing and performance reporting.
Key Challenges in Pathology Billing and Revenue Management
The billing of pathology is a unique yet intricate speciality, demanding high accuracy and complete knowledge, and frequent regulatory awareness. Without the help of the correct expertise, practitioners may find it’s hard to maintain revenue and face losses along with compliance issues.
- Complex coding requirements: Pathology processes are highly demanding and involve ICD, CPT, and HCPCS codes that are to be used correctly.
- Frequent evolving regulations: Compliance with consistently changing Medicare, Medicaid, and commercial payer policies are crucial and difficult to maintain.
- Increase risk of claim denials: Minor coding or documentation error can cause delays and denials that are costly.
- Bundling or unbundling:Misunderstanding which services should be reported together or separately can affect reimbursement.
- Limited in-house billing expertise: Many pathology groups lack staff with specialized billing knowledge.
- Revenue leakage: Missed charges, undercoding, or late submissions can lead to substantial financial loss.
Most Used CPT Codes in Pathology Billing
Surgical Pathology CPT Codes
Surgical pathology includes the examination of tissues that are removed during the surgery for diagnostic purposes. These services are billed using CPT codes 88300–88399. These codes cover different procedures such as
- 88300– Level I surgical pathology, gross examination under Surgical Pathology, Gross and Microscopic (88300-88309).
- 88319– Determinative histochemistry or cytochemistry to identify enzyme constituents, per specimen under Special Stains and Procedures (88312-88319).
- 88344: Immunohistochemistry (including tissue immunoperoxidase), each multiplex antibody stain procedure under Immunohistochemistry (88342-88349).
Cytopathology CPT Codes
Main focus of Cytopathology is the examination of cells, especially from body fluids or fine-needles aspiration, for diagnostic purposes. CPT codes 88104–88199 are used to report cytopathology services.
- 88164: Cytopathology, cervical or vaginal, with manual screening and rescreening under Gynaecological Cytology (88164-88167).
- 88104: Cytopathology, fluids, washings or brushings, with centrifugation under the Fluid Cytology (88104-88109)
88172: Cytopathology, evaluation of fine needle aspirate with interpretation and report under Non-Gynecologic Cytology (88172-88177).
Reversing these effects can be achieved by contracting with pathology billing specialists like EZ MedBill. Our all-inclusive RCM services optimize processes and boost revenue results, from precise coding and billing to credentialing and performance reporting.
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