Introduction
New Way of Thinking
Future of Reimbursement
CPT Coding Guidelines
CPT Terminology Format
Coding Flowcharts
- Quantitative vs. Qualitative
- Specimen Codes
- Each Specimen or Each Analyte
- Free and Total Studies
- Only and Screen Tests
- Each Antigen or Each Antibody
- Antigens or Antibodies
- With or Without Studies
- In Addition Studies
Category III CPT Codes
HCPCS Alternate Codes
Revenue Center Codes
National Correct Coding Initiative
- Procedure-to-Procedure Edits
- Add-on Edits
Medically Unlikely Edits
Other Coding Guidance
- National Coverage Determinations
- Local Coverage Determinations
Routine Screening Tests
Reasonable and Necessary Denials
Frequency Limits
Tests Not Ordered by Qualified Provider
Diagnosis Coding Guidelines for Labs
ICD-10 Coding System
CLIA Compliance
Medicare Packaging of Lab Tests
Chapter 1: Organ and Disease Panels
Standard and Custom Panels
Screening Tests
Duplicate Billing
ESRD Composite Rate Billing
Organ or Disease-Oriented Panels
Billing and Coding Tips
Coding Changes for 2022
Chapter 2: Drug Testing
Drugs of Abuse Analysis
Presumptive Drug Analysis
- Reporting of Presumptive Drug Analysis
Definitive Drug Analysis
- Reporting of Definitive Drug Analysis
- Opioids and Opiate Analogs
Billing and Coding Tips
Coding Changes for 2022
Chapter 3: Therapeutic Drug Assays
Multiple Tests
Unlisted Tests
Billing and Coding Tips
Coding Changes for 2022
Chapter 4: Urinalysis
Routine Urinalysis
Other Urinalysis
Coding Flowchart
Billing and Coding Tips
Coding Changes for 2022
Chapter 5: Molecular Pathology
Tier 1/Tier 2
Geonomic Sequencing Procedures and Other Molecular
Analyte Assays
Multianalyte Algorithmic Assay
Proprietary Laboratory Analyses
Professional Interpretation
ADLT Date of Service
Payment
Coding Changes for 2022
- Additions
- Revisions
- Deletions
Chapter 6: Chemistry Testing
Custom Profiles and Panels
Comprehensive Codes
When the Specimen Matters
When the Method Matters
Frequency, Overutilization and Medical Necessity
- Example: Blood Glucose Testing
Billing and Coding Tips
Coding Changes for 2022
Chapter 7: Hematology
Standardized Chargemaster for
Multisite Facilities
Customizing Test Descriptions
Chargemaster-Driven Overutilization
Compliance Issues
- Reflex Testing vs. Quality Assurance
- Prescription Pad Orders
Coding Flowchart
Billing and Coding Tips
Coding Changes for 2022
Chapter 8: Coagulation Testing
Custom Profiles and Panels
Medical Necessity Versus Screening
Standing Orders Versus Recurring Orders
Frequency Limits and Overutilization
Coding Flowchart
Billing and Coding Tips
Coding Changes for 2022
Chapter 9: Immunology
Compliance Issues
- Reflex Testing
- NCCI and Medically Unlikely Edits
- Authoritative Resources
Billing and Coding Tips
Coding Changes for 2022
Chapter 10: Microbiology
Matching Order Options to the Chargemaster
Submitting Follow-up Test Codes
Culture of Pathogen and Detection of Infectious Agent
Infectious Antigen Detection
To Recap the Issues
Coding Flowchart
Billing and Coding Tips
Coding Changes for 2022
- Addition
- Revisions
- Deletion
Chapter 11: Blood Banking and Transfusion Medicine
Billing for the Blood Product
Crossmatch Codes
Retyping the Units
- Code Assignment for Transfusion Medicine Services
Blood Transfusions
Billing and Coding Tips
Coding Changes for 2022
Chapter 12: Cytopathology
Non-Gynecological Specimens
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Gynecological Specimens
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Coding Changes for 2022
Fine Needle Aspirate
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Coding Changes for 2022
Flow Cytometry
Billing and Coding Tips
Coding Changes for 2022
Chapter 13: Cytogenetic Studies
Coding Flowchart
Billing and Coding Tips
Coding Changes for 2022
Chapter 14: Surgical Pathology and Histology
Outpatient Payment and APCs
Unit of Service
- Date of Service Rules for Histology
Specimen Processing, Special Stains and
Other Related Procedures
Billing and Coding Tips
Frozen Section
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Touch Prep
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Antibody Techniques
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Bone Marrow Studies
Prostate Biopsy Mapping Specimens
Morphometric Analysis
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Nerve Teasing
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
In situ Hybridization
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Protein Analysis of Tissue by Western Blot
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Dissection and Microdissection Procedures
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Postmortem Examination
- CPT/HCPCS Codes
- Intended Use of Codes
Billing and Coding Tips
Coding Changes for 2022
Chapter 15: In Vivo (Transcutaneous)
Procedures, Miscellaneous Testing,
Reproductive Medicine
Handling or Shipping Fees
In Vivo (Transcutaneous) Procedures
Specimen Collection (Venipunctures, Finger-sticks and
Arterial Punctures)
Travel Allowance
Continuous Glucose Monitoring (CGM)
Billing and Coding Tips
Coding Changes for 2022
Chapter 16: Preventive Screening Procedures
Prostate Antigen Screening for Adenocarcinoma
Fecal Occult Blood Screening for Colorectal Cancer
Measurement of Lipid Levels to Screen for
Cardiovascular Disease
Diabetes Screening
Human Immunodeficiency Virus
Sexually Transmitted Infections (STIs)
Hepatitis C Virus Screening
Billing and Coding Tips
Chapter 17: Payment Methods for Clinical
Laboratory and Professional Services
Pathology Payment Methods
- Column 1: HCPCS
- Column 2: Mod (Modifier)
- Column 3: MPFS Status Code
- Column 4: MPFS PC/TC Indicator
- Column 5: MPFS Work RVU
- Column 6: MPFS Facility RVU
- Column 7: Non-Facility RVU
- Column 8: MPFS Conversion Factor
- Column 9: OPPS Status Indicator
- Column 10: OPPS APC Rate
- Column 11: CLFS 2022 Payment
Clinical Pathology Consultations
Consultations on Referred Material
Chapter 18: COVID-19 Testing
Recent Coding Changes
COVID-19 FAQs
Modifiers Used During the COVID-19 Public Health
Emergency (PHE)
Appendix A: Medicare Manuals
Appendix B: Medicare Quality
Payment Programs
MACRA
MIPS
Advanced APMs
Tips for Quality Compliance
