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CPT Coding Basics for Histologists


CPT stands for Current Procedural Terminology. CPT codes are service codes that identify medical procedures. Today they are used primarily for billing purposes for reimbursement, so they are used by insurance companies to quickly note what type of care was provided. CPT was initially created in the mid 1960’s by the American Medical Association (AMA), at which time it focused on only surgical procedures. Several editions were released in the 1970’s broadening CPT’s scope. CPT became widely used after CMS adopted it in 1983 for reporting of physician services for Medicare, and further solidified into everyday use following the Health Insurance Portability and Accountability Act (HIPAA) in the 1990s.


The entire CPT codebook is pretty big, over 800 pages, but there are a limited number of codes that actually deal with surgical pathology.


Let’s talk about some of the key vocabulary you will hear when talking about CPT coding for pathology. One of the most important terms is “Unit of Service”. For codes 88300-88309, the unit of service is the specimen. CPT defines specimen as “tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathologic diagnosis. Two or more such specimens from the same patient (eg, separately identified endoscopic biopsies, skin lesions, etc) are each appropriately assigned an individual code reflective of its proper level of service.”


Code 88300 is used for a specimen that can be diagnosed without microscopic examination. Code 88302 is used for a specimen that is being examined for identification and absence of disease. This might include something like an amputation or newborn foreskin. The rest of the codes 88304-88309 are other specimens that need microscopic examination, with various levels of physician work. In addition to these codes, there are “add-on codes” when additional services beyond accession, examination, and reporting are required. These codes are included in addition to the 88300-88309 grossing/microscopic evaluation code. For example, + 88311 indicates decalcification.


Codes 88312 and 88313 refer to special stains. Special stains for microorganisms are coded 88312, while non-microorganism histochemical stains are coded 88313. You may also see 88319 which is for enzyme histochemistry, 88329 which is for frozen sectioning, and 88342 which is IHC.


To learn more about CPT coding for surgical pathology, check out the online course, CPT® Coding Basics for Histotechnologists, part of the 2020 Symposium/Convention Laboratory Operations Package on NSH's Online Learning Center.


References:

https://med.uth.edu/orl/2009/12/11/current-procedural-technology-history-structure-process-controversies/

http://a1.mayomedicallaboratories.com/webjc/attachments/53/05c49d7-surgical-pathology.pdf

https://basicmedicalkey.com/coding-and-billing/

https://www.ama-assn.org/practice-management/cpt/cpt-overview-and-code-approval

https://academic.oup.com/labmed/article/42/4/242/2504985


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