Skip to content 
Pathology is all about understanding diseases by studying things like bodily fluids, tissues, and organs. It plays a vital role in helping doctors diagnose and manage various health conditions. But behind the scenes, getting paid for these services depends on accurate coding and billing.
Healthcare providers use the Current Procedural Terminology (CPT) code set to document their medical procedures and services. In pathology, different CPT code ranges are used to ensure insurance companies accurately represent and reimburse the services.
Updates to CPT® for Pathology & Laboratory Services Effective
Annually, the CPT® codebook undergoes revisions to reflect advancements in medical technology, techniques, and services. To support our clients, Tranquil Medical Billing has compiled a summary of these updates to ensure accurate reporting starting January 1, 2024.
For the upcoming year, the American Medical Association (AMA) has added 126 new codes and revised 52 others, with several updates relevant to pathology.
Outlined below are the specific changes, where new codes are indicated in red, revised codes in blue, and deleted codes in black.
Pathology and Laboratory
New CPT® Codes for 2024
➤ 81457: Solid organ neoplasm genomic analysis panel for sequence variants; includes DNA analysis and microsatellite instability.
➤ 81458: Solid organ neoplasm genomic analysis panel for sequence variants; includes DNA analysis, copy number variants, and microsatellite instability.
➤ 81459: Solid organ neoplasm genomic analysis panel for sequence variants; combines DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.
➤ 81462: Solid organ neoplasm genomic analysis panel using cell-free nucleic acid (e.g., plasma) for sequence variants; includes DNA or combined DNA and RNA analysis, copy number variants, and rearrangements.
➤ 81463: Solid organ neoplasm genomic analysis panel using cell-free nucleic acid (e.g., plasma) for sequence variants; includes DNA analysis, copy number variants, and microsatellite instability.
➤ 81464: Solid organ neoplasm genomic analysis panel using cell-free nucleic acid (e.g., plasma) for sequence variants; combines DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements.
➤ 81517: Liver disease biomarker analysis of 3 markers (HA, PIIINP, TIMP-1) via immunoassays; serum used for prognostic risk score and 5-year liver fibrosis risk.
➤ 82166: Anti-Müllerian hormone (AMH) test.
➤ 86041: Acetylcholine receptor (AChR) binding antibody test.
➤ 86042: Acetylcholine receptor (AChR) blocking antibody test.
➤ 86043: Acetylcholine receptor (AChR) modulating antibody test.
➤ 86366: Muscle-specific kinase (MuSK) antibody test.
➤ 87523: Nucleic acid detection for hepatitis D (delta); includes quantification and reverse transcription if performed.
Digital Pathology Category III codes, including those introduced in 2023, are listed here with their primary CPT codes for clarity.
| CPT Code | Add-on Charge | Description |
|---|---|---|
| 88302 | +0751T | Digitization of glass microscope slides for level II surgical pathology; gross and microscopic examination (listed separately with primary procedure). |
| 88304 | +0752T | Digitization of glass microscope slides for level III surgical pathology; gross and microscopic examination (listed separately with primary procedure). |
| 88305 | +0753T | Digitization of glass microscope slides for level IV surgical pathology; gross and microscopic examination (listed separately with primary procedure). |
| 88307 | +0754T | Digitization of glass microscope slides for level V surgical pathology; gross and microscopic examination (listed separately with primary procedure). |
| 88309 | +0755T | Digitization of glass microscope slides for level VI surgical pathology; gross and microscopic examination (listed separately with primary procedure). |
| 88312 | +0756T | Special stain, including interpretation and report, group I for microorganisms (e.g., acid fast, methenamine silver) (listed separately with primary procedure). |
| 88313 | +0757T | Special stain, including interpretation and report, group II for other stains (e.g., iron, trichrome) (listed separately with primary procedure). |
| 88314 | +0758T | Special stain, including interpretation and report, histochemical stain on frozen tissue block (listed separately with primary procedure). |
| 88319 | +0759T | Special stain, including interpretation and report, group III for enzyme constituents (listed separately with primary procedure). |
| 88342 | +0760T | Immunohistochemistry or immunocytochemistry, initial single antibody stain per specimen (listed separately with primary procedure). |
| 88341 | +0761T | Immunohistochemistry or immunocytochemistry, each additional single antibody stain per specimen (listed separately with primary procedure). |
| 88344 | 0762T | Immunohistochemistry or immunocytochemistry, each multiplex antibody stain per specimen (listed separately with primary procedure). |
| 88360 | +0763T | Morphometric analysis for tumor immunohistochemistry (e.g., Her-2/neu) per specimen, each single antibody stain procedure, manual (listed separately with primary procedure). |
| 88104 | +0827T | Digitization of glass microscope slides for cytopathology; fluids, washings, or brushings (except cervical/vaginal) with interpretation (listed separately with primary procedure). |
| 88106 | +0828T | Simple filter method with interpretation (listed separately with primary procedure). |
| 88108 | +0829T | Digitization of glass microscope slides for cytopathology; concentration technique with interpretation (e.g., Saccomanno technique) (listed separately with primary procedure). |
| 88112 | +0830T | Digitization of glass microscope slides for cytopathology; selective-cellular enhancement technique with interpretation (e.g., liquid-based slide preparation) (listed separately with primary procedure). |
| 88141 | +0831T | Digitization of glass microscope slides for cytopathology; cervical or vaginal requiring physician interpretation (listed separately with primary procedure). |
| 88160 | +0832T | Digitization of glass microscope slides for cytopathology; smears from other sources; screening and interpretation (listed separately with primary procedure). |
| 88161 | +0833T | Preparation, screening, and interpretation of smears (listed separately with primary procedure). |
| 88162 | +0834T | Extended study involving over 5 slides and/or multiple stains (listed separately with primary procedure). |
| 88172 | +0835T | Digitization of glass microscope slides for cytopathology; evaluation of fine needle aspirate; immediate cytohistologic study for adequacy, first evaluation episode (listed separately with primary procedure). |
| 88177 | +0836T | Immediate cytohistologic study for adequacy, each additional evaluation episode, same site (listed separately with primary procedure). |
| 88173 | +0837T | Interpretation and report (listed separately with primary procedure). |
| 88321 | +0838T | Digitization of glass microscope slides for consultation and report on referred slides prepared elsewhere (listed separately with primary procedure). |
| 88323 | +0839T | Digitization of glass microscope slides for consultation and report on referred slides prepared elsewhere (listed separately with primary procedure). |
| 88325 | +0840T | Digitization of glass microscope slides for comprehensive pathology consultation; includes record and specimen review (listed separately with primary procedure). |
| 88331 | +0841T | Digitization of glass microscope slides for pathology consultation during surgery; first tissue block with frozen section(s) (listed separately with primary procedure). |
| 88332 | +0842T | Each additional tissue block with frozen section(s) (listed separately with primary procedure). |
| 88333 | +0843T | Cytologic examination (e.g., touch preparation, squash preparation) for initial site (listed separately with primary procedure). |
| 88334 | +0844T | Cytologic examination (e.g., touch preparation, squash preparation) for each additional site (listed separately with primary procedure). |
| 88346 | +0845T | Digitization of glass microscope slides for immunofluorescence, per specimen; initial single antibody stain procedure (listed separately with primary procedure). |
| 88350 | +0846T | Each additional single antibody stain procedure (listed separately with primary procedure). |
| 88363 | +0847T | Digitization of glass microscope slides for examination and selection of archival tissue(s) for molecular analysis (e.g., KRAS mutational analysis) (listed separately with primary procedure). |
| 88365 | +0848T | Digitization of glass microscope slides for in situ hybridization (e.g., FISH), per specimen; initial single probe stain procedure (listed separately with primary procedure). |
| 88364 | +0849T | Each additional single probe stain procedure (listed separately with primary procedure). |
| 88366 | +0850T | Each multiplex probe stain procedure (listed separately with primary procedure). |
| 88368 | +0851T | Digitization of glass microscope slides for morphometric analysis, in situ hybridization (quantitative or semiquantitative), manual, per specimen; initial single probe stain procedure (listed separately with primary procedure). |
| 88369 | +0852T | Each additional single probe stain procedure (listed separately with primary procedure). |
| 88377 | +0853T | Each multiplex probe stain procedure (listed separately with primary procedure). |
| 85060 | +0854T | Digitization of glass microscope slides for blood smear; peripheral interpretation by physician with written report (listed separately with primary procedure). |
| 85097 | +0855T | Digitization of glass microscope slides for bone marrow smear interpretation (listed separately with primary procedure). |
| 88348 | +0856T | Digitization of glass microscope slides for electron microscopy; diagnostic (listed separately with primary procedure). |
Revised Codes for 2024
- 81171: ⚙️ ALF transcription elongation factor 2 (FMR2) gene analysis for detecting abnormal alleles (e.g., expanded) linked to fragile X intellectual disability 2 (FRAXE).
- 81172: ⚙️ ALF transcription elongation factor 2 (FMR2) gene analysis for characterizing alleles, including expanded size and methylation status related to fragile X intellectual disability 2 (FRAXE).
- 81243: 🔍 FMR1 gene analysis to evaluate abnormal alleles (e.g., expanded) associated with fragile X syndrome and X-linked intellectual disability (XLID).
- 81244: 🧬 FMR1 gene analysis for characterizing alleles, focusing on expanded size and promoter methylation status related to fragile X syndrome and X-linked intellectual disability (XLID).
Revisions only listed for 81403-81407. Refer to CPT for complete code detail:
| CPT Code | Description |
|---|---|
| 81403 | Level 4 molecular pathology for ARX (aristaless related homeobox); duplication/deletion analysis for X-linked lissencephaly and intellectual disability. |
| 81404 | Level 5 molecular pathology for ARX; full gene sequence, plus ZNF41 for X-linked intellectual disability 89. |
| 81405 | Level 6 molecular pathology for FTSJ1; duplication/deletion analysis for X-linked intellectual disability 9. |
| 81406 | Level 7 molecular pathology for FTSJ1; full gene sequence for X-linked intellectual disability 9. |
| 81407 | Level 8 molecular pathology for KDM5C; full gene sequence for X-linked intellectual disability. |
| 81445 | Genomic sequence analysis for solid organ neoplasms (5-50 genes); interrogates sequence and copy number variants; DNA or combined DNA/RNA analysis. |
| 81449 | Genomic sequence analysis for solid organ neoplasms (5-50 genes); interrogates sequence and copy number variants; RNA analysis. |
| 81450 | Genomic sequence analysis for hematolymphoid neoplasms (5-50 genes); interrogates sequence variants, copy number variants, or mRNA expression; DNA or combined DNA/RNA analysis. |
| 81451 | Genomic sequence analysis for hematolymphoid neoplasms (5-50 genes); interrogates sequence variants, copy number variants, or mRNA expression; RNA analysis. |
| 81455 | Genomic sequence analysis for solid organ or hematolymphoid neoplasms (51+ genes); interrogates variants and mRNA expression; DNA or combined DNA/RNA analysis. |
| 81456 | Genomic sequence analysis for solid organ or hematolymphoid neoplasms (51+ genes); interrogates variants and mRNA expression; RNA analysis. |
No deleted codes for 2024
Evaluation and Management
New codes for 2024
99459: Pelvic examination; reported separately in addition to the primary procedure code.
Updates for 2024
| CPT Code | Description |
|---|---|
| 99202 | Office visit for a new patient requiring a medical history/exam and straightforward decision-making. Total time must be at least 15 minutes. |
| 99203 | Office visit for a new patient needing a medical history/exam and low-level decision-making. Total time must be at least 30 minutes. |
| 99204 | Office visit for a new patient requiring a medical history/exam and moderate decision-making. Total time must be at least 45 minutes. |
| 99205 | Office visit for a new patient needing a medical history/exam and high-level decision-making. Total time must be at least 60 minutes. |
| 99212 | Office visit for an established patient requiring a medical history/exam and straightforward decision-making. Total time must be at least 10 minutes. |
| 99213 | Office visit for an established patient needing a medical history/exam and low-level decision-making. Total time must be at least 20 minutes. |
| 99214 | Office visit for an established patient requiring a medical history/exam and moderate decision-making. Total time must be at least 30 minutes. |
| 99215 | Office visit for an established patient needing a medical history/exam and high-level decision-making. Total time must be at least 40 minutes. |
| 99306 | Initial nursing facility care requiring a medical history/exam and high-level decision-making. Total time must be at least 50 minutes. |
| 99308 | Subsequent nursing facility care requiring a medical history/exam and low-level decision-making. Total time must be at least 20 minutes. |
No deleted codes for 2024
New Codes for Late 2023 and 2024
| CPT Code | Description |
|---|---|
| 90480 | Administration of a single dose of SARS-CoV-2 (COVID-19) vaccine via intramuscular injection. Previous codes will be deleted on 11/1/2023. |
| 90589 | Live attenuated chikungunya virus vaccine for intramuscular use. |
| 90623 | Conjugated meningococcal pentavalent vaccine (Men A, C, W, Y with tetanus toxoid carrier, and Men B-FHbp) for intramuscular use. |
| 90683 | mRNA lipid nanoparticles respiratory syncytial virus vaccine for intramuscular use. |
Pfizer: Effective date 9/11/2023
- 91318: SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, 3 mcg/0.3 mL, tris-sucrose formulation, for intramuscular use.
- 91319: SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, 10 mcg/0.3 mL, tris-sucrose formulation, for intramuscular use.
- 91320: SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL, tris-sucrose formulation, for intramuscular use. Effective date: 9/11/2023 (Moderna)
- 91321: SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, 25 mcg/0.25 mL, for intramuscular use.
- 91322: SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, 50 mcg/0.5 mL, for intramuscular use.
Revised Codes for Late 2023 and 2024 – Effective 8/14/23
91304: SARS-CoV-2 (COVID-19) vaccine 🦠, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL, for intramuscular use.
Deleted codes for Late 2023 and 2024 – Effective 11/1/23
| Code | Description |
|---|---|
| 0001A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL); first dose |
| 0002A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL); second dose |
| 0003A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL); third dose |
| 0004A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL); booster dose |
| 0011A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL); first dose |
| 0012A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL); second dose |
| 0013A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 100 mcg/0.5mL); third dose |
| 0021A | Intramuscular injection of SARS-CoV-2 vaccine (DNA, spike protein, ChAdOx1 vector, preservative-free, 5×1010 viral particles/0.5mL); first dose |
| 0022A | Intramuscular injection of SARS-CoV-2 vaccine (DNA, spike protein, ChAdOx1 vector, preservative-free, 5×1010 viral particles/0.5mL); second dose |
| 0031A | Intramuscular injection of SARS-CoV-2 vaccine (DNA, spike protein, Ad26 vector, preservative-free, 5×1010 viral particles/0.5mL); single dose |
| 0034A | Intramuscular injection of SARS-CoV-2 vaccine (DNA, spike protein, Ad26 vector, preservative-free, 5×1010 viral particles/0.5mL); booster dose |
| 0041A | Intramuscular injection of SARS-CoV-2 vaccine (recombinant spike protein nanoparticle, saponin-based adjuvant, preservative-free, 5 mcg/0.5 mL); first dose |
| 0042A | Intramuscular injection of SARS-CoV-2 vaccine (recombinant spike protein nanoparticle, saponin-based adjuvant, preservative-free, 5 mcg/0.5 mL); second dose |
| 0044A | Intramuscular injection of SARS-CoV-2 vaccine (recombinant spike protein nanoparticle, saponin-based adjuvant, preservative-free, 5 mcg/0.5 mL); booster dose |
| 0051A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3 mL, tris-sucrose); first dose |
| 0052A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3 mL, tris-sucrose); second dose |
| 0053A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3 mL, tris-sucrose); third dose |
| 0054A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3 mL, tris-sucrose); booster dose |
| 0064A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 50 mcg/0.25 mL); booster dose |
| 0071A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL, diluent reconstituted, tris-sucrose); first dose |
| 0072A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL, diluent reconstituted, tris-sucrose); second dose |
| 0073A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL, diluent reconstituted, tris-sucrose); third dose |
| 0074A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL, diluent reconstituted, tris-sucrose); booster dose |
| 0081A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 3 mcg/0.2 mL, diluent reconstituted, tris-sucrose); first dose |
| 0082A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 3 mcg/0.2 mL, diluent reconstituted, tris-sucrose); second dose |
| 0083A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 3 mcg/0.2 mL, diluent reconstituted, tris-sucrose); third dose |
| 0091A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 50 mcg/0.5 mL); first dose for individuals 6 to 11 years |
| 0092A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 50 mcg/0.5 mL); second dose for individuals 6 to 11 years |
| 0093A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 50 mcg/0.5 mL); third dose for individuals 6 to 11 years |
| 0094A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 50 mcg/0.5 mL); booster dose for individuals 6 to 11 years |
| 0095A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL); first dose for individuals 6 to 11 years |
| 0096A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL); second dose for individuals 6 to 11 years |
| 0097A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL); third dose for individuals 6 to 11 years |
| 0098A | Intramuscular injection of SARS-CoV-2 vaccine (mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL); booster dose for individuals 6 to 11 years |
References:
- American Medical Association (AMA) Current Procedural Terminology (CPT) 2024. Retrieved from https://www.ama-assn.org/press-center/press-releases/ama-releases-cpt-2024-code-set
Surgical Pathology CPT ® Codes
The field of surgical pathology centers on the analysis of tissue samples taken during surgical interventions. Surgical pathology services fall under the CPT code range of 88300-88399.
These codes cover procedures such as:
Surgical Pathology, Gross & Microscopic Examination (88300-88309)
- 88300: Level I surgical pathology, gross examination only
- 88302: Level II surgical pathology, gross and microscopic examination
- 88304: Level III surgical pathology, gross and microscopic examination
- 88305: Level IV surgical pathology, gross and microscopic examination
- 88307: Level V surgical pathology, gross and microscopic examination
These codes are used to report the examination of tissue samples, with different levels of complexity depending on how thorough the examination is and what type of sample it is.
| Code | Description |
|---|---|
| 81171 | Tests the AFF2 gene for abnormal alleles linked to fragile X intellectual disability. |
| 81172 | Assesses the AFF2 gene for allele size and methylation status related to fragile X intellectual disability. |
| 81243 | Evaluates the FMR1 gene for abnormal alleles linked to fragile X syndrome and X-linked intellectual disability. |
| 81244 | Characterizes FMR1 alleles to assess size and promoter methylation status related to fragile X syndrome. |
| 81403 | Analyzes the ARX gene for duplications or deletions linked to X-linked lissencephaly and intellectual disability. |
| 81404 | Full gene sequence analysis of ARX or ZNF41 related to X-linked lissencephaly and intellectual disability. |
| 81405 | Tests the FTSJ1 gene for duplications or deletions linked to X-linked intellectual disability 9. |
| 81406 | Full gene sequence analysis of FTSJ1 associated with X-linked intellectual disability 9. |
| 81407 | Full gene sequence analysis of KDM5C gene linked to X-linked intellectual disability. |
| 81445 | Genomic panel for solid organ tumors, testing 5-50 genes for DNA and RNA variants. |
| 81449 | Genomic panel for solid organ tumors, analyzing 5-50 genes for RNA variants. |
| 81450 | Genomic panel for hematolymphoid tumors, testing 5-50 genes for DNA and RNA variants. |
| 81451 | Genomic panel for solid or hematolymphoid tumors, testing 51+ genes for DNA and RNA variants. |
| 81455 | Genomic panel for solid or hematolymphoid tumors, analyzing 51+ genes for RNA variants. |
| 81456 | Genomic panel for solid or hematolymphoid tumors, analyzing 51+ genes for RNA variants. |
Special Stains and Procedures: CPT ®88312-88319
- 88312: Special stains (for microorganisms, stains for enzyme constituents, etc.)
- 88313: Histochemical staining with frozen section(s)
- 88314: Histochemical staining with frozen section(s), including interpretation and report
- 88319: Determinative histochemistry or cytochemistry to identify enzyme constituents, per specimen
These codes are associated with specialized staining methods designed to help identify particular structures or substances found in tissue samples.
Immunohistochemistry (IHC): CPT ® 88342-88349
- 88342: IHC (including tissue immunoperoxidase), each antibody
- 88344: IHC (including tissue immunoperoxidase), each multiplex antibody stain procedure
- 88346: Immunofluorescent study, each antibody
- 88348: Electron microscopy, diagnostic
Advanced methods like immunohistochemistry and electron microscopy are used to find specific antigens or cellular structures. These techniques play a key role in ensuring accurate diagnoses.
Cytopathology CPT ® Codes
Cytopathology focuses on the study of cells from body fluids or fine needle aspirates. The CPT codes for cytopathology services range from 88104 – 88199.
Some commonly used codes include:
GYN Cytology: CPT ® 88164-88167
- 88164: Cytopathology of cervical or vaginal samples with manual screening and rescreening.
- 88165: Cytopathology of cervical or vaginal samples with manual screening and rescreening, interpreted by a physician or qualified healthcare professional.
- 88166: Cytopathology of cervical or vaginal samples with automated screening and rescreening.
- 88167: Cytopathology of cervical or vaginal samples with automated screening and rescreening, interpreted by a physician or qualified healthcare professional.
These codes are for checking cervical or vaginal samples, like Pap smears. They vary in complexity depending on how the screening and interpretation are done.
Non-GYN Cytology: CPT ® 88172-88177
- 88172: Cytopathology, assessment of fine needle aspirate with interpretation and report.
- 88173: Cytopathology, assessment of additional fine needle aspirate evaluation with interpretation and report.
- 88177: Cytopathology, further evaluation of fine needle aspirate with interpretation and report.
These codes apply to the assessment of non-gynecologic cytology specimens, including fine-needle aspirates from different body areas.
Fluid Cytology: CPT ® 88104-88109
- 88104: Cytopathology, fluids, washings or brushings, with centrifugation
- 88106: Cytopathology, fluids, washings or brushings, with simple filter technique
- 88108: Cytopathology, fluids, washings or brushings, with concentration technique
These codes are for analyzing fluid cytology specimens, like pleural, peritoneal, or bronchial washings, using different preparation methods.
Molecular Pathology CPT ® Codes
Molecular pathology studies genetic and molecular changes in diseases and includes CPT codes from 81105 to 81599.
Some commonly used codes include:
Molecular Pathology Procedures: CPT ® 81200-81299
- 81206: BCR/ABL1 gene mutations (major and minor breakpoints)
- 81210: BRAF gene analysis for V600 mutations
- 81215: BRCA1 and BRCA2 gene analysis for breast and ovarian cancer risk
These codes focus on identifying specific gene mutations related to conditions such as leukemia, melanoma, and breast and ovarian cancers. Their use aids in better understanding and treating these diseases.
Molecular Cytogenetics: CPT ® 81300-81399
- 81315: PML/RARalpha gene test for risk of acute promyelocytic leukemia
- 81335: TERT gene test for risk of thyroid cancer
- 81347: SF3B1 gene test for myelodysplastic syndrome and acute myeloid leukemia
These codes focus on assessing chromosomal changes and gene rearrangements related to various blood cancers and solid tumors.
Molecular Pathology Procedure Level: Codes 81400-81408
- 81400: Molecular pathology procedure, Level 1
- 81403: Molecular pathology procedure, Level 4
- 81408: Molecular pathology procedure, Level 9
These codes categorize molecular pathology procedures by their technical difficulty and resource needs, ranging from Level 1 (least complex) to Level 9 (most complex).
Anatomic Pathology Consultation CPT ® Codes
Pathologists may occasionally seek input from other specialists or pathologists for further expertise or a second opinion. The CPT code range for consultations in anatomic pathology is 88321-88325.
These codes include:
Consultation and Report: CPT ® 88321-88325
- 88321: Consultation and report for referred materials needing slide preparation.
- 88323: Consultation and report for referred materials without slide preparation.
- 88325: Detailed review and report on patient materials, including diagnostic problem-solving.
These codes apply when a pathologist consults on referred materials, whether or not slides are prepared, or conducts a thorough review for diagnostic problem-solving.
Important Factors for Coding and Billing
Follow key guidelines and best practices for coding and billing pathology services:
1. Keep Clear Documentation: To ensure proper coding and billing for pathology services, having precise and detailed documentation is critical. Pathologists should record all relevant information about the specimen, procedures, and findings to avoid errors.
2. Ensure Medical Necessity: Pathology services should always be necessary for diagnosing or treating the patient’s condition. If services aren’t justified or supported by clinical documentation, payers may reject the claim.
3. Use Specific Codes: Always select the most specific CPT codes that accurately describe the service. This not only guarantees correct reimbursement but also aids in research and quality tracking.
4. Apply Modifiers When Needed: In some cases, modifiers are necessary to provide extra context or special circumstances for a pathology service. Make sure to use modifiers like 26 for professional components, TC for technical components, and 91 for repeat tests where applicable.
5. Understand Global Periods: Some services are bundled into global periods, which means additional related services aren’t billed separately. Being aware of these periods helps prevent billing errors and ensures compliance.
6. Follow Bundling Rules: Be aware of the bundling and unbundling rules to avoid overcharging or undercharging for services. Properly bundling services ensures that billing is both accurate and fair.
7. Stay Audit-Ready: Regularly conducting audits ensures compliance and prevents billing errors. Implementing strong auditing programs reduces the risk of denied claims and supports proper reimbursement.
Final Thoughts
Accurate coding and billing are essential in pathology services, which play a critical role in diagnosing and treating medical conditions. By using the correct CPT codes, providers can not only ensure proper reimbursement but also contribute to data analysis, quality improvements, and research advancements.
Given that coding and billing guidelines are regularly updated, it’s important to stay informed and seek expert advice when necessary. By keeping up with changes and adhering to best practices, providers can maintain compliance and ensure accurate billing processes moving forward.
