Are you following the latest pathology coding guidelines? Or is your revenue slipping through your fingers due to coding errors? Pathology acts as a bridge between science and medicine. It provides diagnostic information about patients so healthcare providers can offer the correct treatment.
Unfortunately, many pathology labs have to absorb the financial impact of an inefficient billing process. According to XiFin, a healthcare information technology company, around 20% of routine pathology claims are denied due to eligibility issues, outdated practices, poor documentation, missing modifiers, and other billing mistakes. If coding is your main concern, go through the common pathology CPT codes of 2024 mentioned below to avoid basic errors.
Most Commonly Used Pathology CPT Codes
We understand that coding is difficult, but it doesn’t have to be! Pathology is a diverse field focusing on the study of diseases. Pathologists perform various tests, from tissue biopsies to molecular testing, to identify and understand different ailments and their effects on the body.
While they are quite adept at routine tasks, they find it difficult to report their services accurately to payers due to hundreds of pathology CPT codes. Frequent coding updates and advancements in the field require pathology coders to update their knowledge continuously.
In short, coding can be overwhelming. However, you can simply follow our list to avoid immediate denials. Here are the most commonly used pathology CPT codes.
Pathology CPT codes for Surgical Procedures
CPT Codes 88300 to 88309 – Surgical Pathology
Surgical pathology analysis has six levels, each represented by capital Roman numbers (I to VI) and indicating a different specimen or level of tissue. CPT codes ranging from 88300 to 88309 refer to these varying levels of examination for surgically removed tissues.
| CPT Code | Description |
|---|---|
| 88300 | Reports the level I analysis of a pathological sample. In simple words, the 88300 pathology CPT code covers the initial steps of preparing a tissue/specimen for gross examination only. |
| 88302 | Highlights the level II examination of a pathological sample. In addition to gross features, CPT code 88302 also covers the microscopic analysis of a specimen to identify a disease or the absence of it. |
| 88304 | Specifies the level III analysis, including gross and microscopic tests of a pathological specimen. This CPT code usually covers the analysis of cysts, tags, and debridement specimens. |
| 88305 | Addresses the fourth level (IV) of surgical pathology, gross and microscopic analysis. CPT code 88305 covers skin excisions and biopsies. |
| 88307 | Notifies payers about the level V evaluation of a surgically removed pathology specimen. For example, billing specialists use the 88307 CPT code to cover simple mastectomies without a lymph node dissection. |
| 88309 | Points towards a sixth level (VI) examination of surgical pathology specimens, including gross and microscopic features. |
CPT Codes 88312 to 88319 – Staining
We know that pathologists use microscopes to analyze surgically removed tissues or specimens to identify diseases. However, sometimes, they need to apply special chemicals to improve the visibility of specific cellular structures, chemical components, or microorganisms in a pathological specimen. This process is known as staining.
Surgical pathology CPT codes ranging from 88312 to 88319 cover different types of staining procedures.
| CPT Code | Description |
|---|---|
| 88312 | It refers to the use of special stains on a pathological specimen to visualize microorganisms. This process also includes interpretation by a pathologist. |
| 88313 | The 88313 CPT code for pathology covers non-microorganism stains, such as iron or trichrome stains. This CPT code usually excludes immunohistochemical (IHC) and enzyme staining. |
| 88314 | The 88314 CPT code specifies a histochemical stain on a frozen tissue block. Billing specialists use this code to report the application of each special stain or frozen surgical block separately. |
| 88319 | Refers to a special stain applied to identify enzyme constituents in various specimens, including biopsies, blood, and bone marrow. |
CPT Code 88346 – Immunofluorescence
This surgical pathology CPT code covers immunofluorescence – a technique that improves the visualization of a cell or tissue’s components. Billing specialists use the 88346 CPT code to report that a lab analyst has used this technique to apply a single antibody stain to a surgically removed tissue or sample.
In short, immunofluorescence makes specific parts of a sample glow under a microscope, allowing pathologists to detect autoimmune diseases or the presence of an infection.
Pathology CPT codes for Organ/Disease Panels
CPT Code 80053 – Comprehensive Metabolic Panel
The 80053 pathology CPT code specifies a comprehensive metabolic panel (CMP) – a routine blood test. Pathologists perform this test to analyze fourteen substances in a patient’s blood, including enzymes, electrolytes, minerals, and proteins.
Simply put, CMP is important for gaining information about a patient’s fluid balance. It allows doctors to assess the overall health of a patient and detect liver, kidney, or metabolism issues.
CPT Code 80061 – Lipid Panel
This pathology CPT code highlights a lipid profile – a group of tests to find abnormalities in fatty compounds. Pathologists use the 80061 CPT code to claim reimbursement for measuring the level of cholesterol and triglycerides (a type of fat) in a patient’s blood. Lipid panel test helps doctors identify cholesterol issues and the risk of heart diseases.
Pathology CPT codes for Hematology & Coagulation Procedures
CPT Code 85018 – Hemoglobin Measurement
Do you only want to check the oxygen levels in the blood? Then, we have the perfect code for you. CPT code 85018 allows you to bill a payer for analyzing hemoglobin in a blood sample. This pigment in red blood cells carries oxygen from the lungs to the rest of the body. Hemoglobin analysis helps doctors diagnose anemia and manage their patients’ chronic conditions.
CPT Code 85027 – Complete Blood Count w/o White Blood Cell Differential
This pathology CPT code falls within the hematology and coagulation procedures category. Pathologists use the 85027 CPT code to refer to a complete blood count (CBC) test without an automatic white blood cell differential. It means that this code only covers a CBC test that counts total white blood cells but doesn’t break them into different types.
During this test, pathology experts also measure hemoglobin (the oxygen-carrying protein in the blood) via a spectrophotometer. Doctors use this blood test to analyze the cells in a patient’s blood, including red and white blood cells and platelets. It helps them assess the overall blood health of a patient.
Pathology CPT codes for Chemistry Procedures
CPT Code 83036 – Hemoglobin A1C Test
This pathology CPT code addresses the A1C test – a common blood analysis used to diagnose type 1 and 2 diabetes. If you work in a pathology lab, you can use the 83036 CPT code to claim reimbursement for measuring the amount of sugar in red blood cells.
The regular A1C level is below 7%. Doctors use this test to determine a patient’s average sugar levels over the past three months (average cell lifespan).
CPT Code 83540 – Iron Test
CPT code 83540 is applied when a pathologist measures the amount of iron in a patient’s blood, usually in the serum. Iron is an essential component of the body. It is mostly found in hemoglobin within red blood cells. This iron test allows healthcare providers to detect and diagnose iron overload or deficiency.
CPT Code 83735 – Magnesium Analysis
This pathology CPT code also addresses a chemical procedure. Pathologists use the 83735 CPT code to notify insurance companies that they have conducted a test to analyze the amount of magnesium in a patient’s specimen, such as blood.
Doctors check magnesium levels to make sure they are within a healthy range so their patients can have healthy muscles, nerves, bones, and sugar levels.
CPT Code 84443 – Analysis of Thyroid Stimulating Hormones (TSH)
Pathology CPT code 84443 reports a thyroid-stimulating hormone (TSH) test. This hormone is produced by the pituitary gland—a gland located at the base of the brain that makes, stores, and releases several hormones.
TSH is important for controlling the thyroid, which, in turn, regulates the energy and metabolism levels of the body. Pathologists perform this test to measure TSH in a patient’s blood through a routine vein puncture.
Pathology CPT codes for Urinalysis Procedures
CPT Code 81001 – Urinalysis Test
This pathology CPT code refers to a urinalysis test. You can use CPT code 81001 to bill insurance companies for checking substances or cells in a patient’s urine to identify urinary tract infections (UTIs), kidney disorders, or other issues.
Pathologists typically perform this test using a dipstick or tablet reagent. They analyze the urine’s color, clarity, and chemical properties, including protein, glucose, and nitrites.
CPT Code 81003 – Automated Urinalysis with Dipstick Reader
This pathology CPT code points towards automated urinalysis. Pathology experts use the 81003 CPT code when they perform this test using a dipstick. After dipping this stick into a fresh urine sample, pathologists place it in a mechanical reader to automatically measure and record key chemical analytes like leukocytes (white blood cells), pH levels, and specific gravity. This automated urinalysis helps to diagnose urinary tract issues.
Pathology CPT Codes for Cytopathology Procedures
CPT Codes 88164 to 88167 – Cytopathology Slide Analysis
Pathology CPT codes ranging from 88164 to 88167 highlight various methods for analyzing and reporting cervical or vaginal cytopathology slides under a physician’s supervision.
| CPT Code | Description |
|---|---|
| 88164 | Used for manually screening the slide and reporting results via the Bethesda System under a physician’s guidance. |
| 88165 | Reports manual screening of a cervical or vaginal cytopathology slide and then rescreening of the same slide. |
| 88166 | Also specifies manual screening of a cervical or vaginal cytopathology slide. The only difference is that a pathologist performs a computer-assisted rescreening for accuracy. |
| 88167 | Refers to a technical, manual lab test of a cervical or vaginal cytopathology slide, followed by computer-assisted rescreening with additional cell selection. |
Pathology CPT codes for Molecular Procedures
CPT Code 81206 – BCR/ABL1 Gene Fusion Analysis
You can use this pathology CPT code to translate a genetic analysis in your claim, which helps doctors diagnose and monitor certain types of leukemia. CPT code 81206 generally refers to a test where a pathologist checks for a specific genetic change, the BCR/ABL1 fusion gene. This change happens on chromosome 22 due to translocation (when a gene breaks and reforms incorrectly).
This BCR/ABL1 gene fusion test can either be qualitative or quantitative. The most important part is that the 81206 CPT code addresses both variations.
CPT Code 81241 – Factor V Leiden Mutation Test
This pathology CPT code addresses a genetic analysis procedure. Pathologists use the 81241 CPT code after performing a technical lab test to detect a specific genetic change, Factor V Leiden mutation (an inherited blood clotting disorder). This analysis helps doctors identify the risk of abnormal blood clotting in Factor V Leiden carriers.
Bottom Line
As you can see, pathology is important for diagnosing and managing various medical conditions. However, with many services, pathologists also have to deal with a wide variety of CPT codes, making it difficult to maintain coding accuracy.
We have provided a list of the most frequently used pathology CPT codes to resolve your coding woes to an extent. But if you still feel overwhelmed with the sheer amount of codes and frequent changes, it is better to partner with a coding expert like MediBill MD. Our pathology billing services can unblock your revenue.
