Pathology and lab billing depends on correct test coding, medical necessity and CLIA rules.
Examples of frequently billed services, with billing notes from our coders.
| CPT code | Service | Billing note |
|---|---|---|
| 88305 | Tissue exam by pathologist, level IV | One of the most frequently billed pathology codes |
| 88342 | Immunohistochemistry, first stain | Each extra stain uses an add-on code |
| 85025 | Complete blood count with automated differential | Check payer frequency edits |
| 80053 | Comprehensive metabolic panel | Do not unbundle panel components |
| 80061 | Lipid panel | Screening vs diagnostic coverage differs |
| 81001 | Urinalysis with microscopy, automated | Waived and non-waived tests differ |
| 36415 | Blood draw by venipuncture | Often limited to one per encounter |
Codes shown are common examples and descriptions are simplified in our own words. CPT® is a registered trademark of the American Medical Association. Always confirm against the current AMA CPT codebook, ICD-10-CM and each payer’s policy.
Modifiers tell the payer how and why a service was performed. Missing or wrong ones are a leading cause of denials.
Eligibility, benefits and prior authorization verified before the visit.
Code, modifier and documentation review before claims are submitted.
Denials corrected and appealed, aging claims worked until resolved.
Diagnostic testing, procedures and E/M claims coded correctly for each payer.
View billing detailsBiopsy, lesion removal and Mohs billing, with medical and cosmetic claims kept separate.
View billing detailsColonoscopy, endoscopy and screening claims coded for the right site and payer.
View billing detailsTalk to our team about your practice, hospital or lab. We will review your current billing and show you where revenue is slipping away.