Much more than a laboratory coding guide…a complete solution to tackle the challenges wrecking your revenues
During these challenging times, you need more than a guide to laboratory coding and billing. Mounting complexity, confusing new rules and continued reductions in reimbursements require a comprehensive solution — this is exactly what you get with
Coding Essentials for Laboratories.
Did you know that some of the new PLA codes coincide with Category I CPT
® codes, increasing the potential for mistakes and payment denials? Are you aware of the ramped-up scrutiny by payers looking for noncompliant practices, such as stacking CPT codes for lab panels? Likewise, Recovery Audit Contractors (RACs) are targeting some laboratory tests for proof of medical necessity. In addition, with the evolving pandemic, several new COVID-19 codes now exist that impact your laboratory services. You can trust that we will deliver the latest guidance for correct reporting.
Coding Essentials for Laboratories, our experts will help you steer clear of these and many other potential pitfalls, you can count on this time-trusted resource to guide you quickly to the correct codes for laboratory and pathology services.
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Features and Benefits
Updated and expanded content, including:
- Explanations and practical application of code changes
- Expanded guidance for Proprietary Laboratory Analyses (PLA) codes; covers the expansion of PLA codes to certain microbiology tests and other services that also have a Category I CPT code — a scenario with a high risk for confusion, miscoding, and claim denials
- Actionable understanding of the new COVID-19 codes for accurate reporting
- Guidance with coding instruction contained in the latest NCCI narrative and the way lab panels may be billed (an area targeted for payer audits)
- Further instruction on drug-of-abuse testing, including clarification of what a presumptive test actually is, how to bill when drug monitoring coincides with drug-of-abuse testing and code unbundling when testing for certain substances
- How to correctly establish medical necessity for vitamin D assay testing
- Updated payment information, including the 2020 CLFS and its impacts
- Proper use of modifier 59
Our experts address common questions, concerns, and problem areas:
- Coding for diagnostic vs. preventive Pap smears
- Billing under a device code or as a lab-developed test
- Coverage limitations for clinical drug testing
- Coding for molecular pathology
Clear, step-by-step guidance through the tasks you perform every day:
- Coding and billing for laboratory and pathology services:
- Drug testing
- Therapeutic drug assays
- Molecular pathology
- Preventive services
- Blood banking
- Transfusion medicine
- And more
A proven quick-reference approach for busy professionals:
- Coding flowcharts for at-a-glance guidance with selecting the correct CPT codes, along with examples of CPT codes to reinforce the correct choices
- Each section includes:
- Explanations of services and the intent of each
- CPT/HCPCS codes and descriptions
- Sample chargemasters
- Coding and billing tips
- Visual flow charts
- Medicare payment information, including quick-reference tables with RVU and APC rates