Surgical Pathology & Cytology Coding Guide

Surgical Pathology and Cytology Coding Guide

Many pathologists and histology laboratories struggle with accurate and consistent coding of surgical pathology and cytology diagnostic services. As a result, many are either under- or over-billing for the services provided. Under-billing can result in a serious financial loss. Over-billing to a government agency (Medicare, Medicaid, etc.) is considered a false claim violation, which carries heavy personal and organizational penalties (sanction, financial settlements, Corporate Integrity Agreement, and criminal and civil penalties, including imprisonment). Such penalties can threaten the future stability of an organization and individual professional careers.

In today's highly regulated and complex healthcare environment, hospital-based pathology practices are at high-risk of unknowingly violating applicable laws and regulations. Coding errors, requisition design faults, and inappropriate billing practices by hospitals or overseeing pathologists or pathology groups can easily result in large fines and government sanctions. Therefore, it is in a pathology practice’s best interest to take aggressive action to properly train their staff, audit their processes to ensure correct coding and billing practices are being used, and implement an effective compliance program to reduce future financial and legal risk.

Organizations may differ on their exact interpretation of the laws, rules, and regulations that govern the coding of anatomic pathology services. This Surgical Pathology & Cytology Coding Guide was created to aid laboratories and pathology professionals in ensuring accurate and consistent diagnostic coding, and in implementing effective compliance programs. The information contained in the Guide has been obtained from several reputable resources (CAP’s Compliance Guide for Pathologists, CAP TODAY, AMA, and related professional newsletters and recognized experts).