New Codes Coming: Is Your Practice Ready?

The clock is ticking for 2022-2023 pathology coding changes. Highlights to date include proposed changes to the 2023 Physician’s Fee Schedule and the addition of category 3 (temporary) digital technology codes that will be add-ons to the primary category 1 CPT (eg: 88305, 88342).

The 2023 ICD-10 changes are slated to go into effect on October 1, 2022. Physician Fee Schedule and new digital pathology codes are effective January 1, 2023. Coronis Health Laboratory and Pathology keeps clients abreast of changes that will affect their billing cycle, preventing revenue disruptions during these events.

2023 Physician Fee Schedule Updates

Centers for Medicare and Medicaid Services (CMS) released its proposed 2023 Medicare Physician Fee Schedule on July 7. The goal of these changes is to ensure more accurate payments for the technical component of pathology next year. They will also decrease pathology payments by about 1% from 2022 to 2023. The conversion factor will also go down by 4.4% to account for the expiration of the 3% fee increase for 2022. 

Digital Pathology: New Category 3 (temporary) Codes Effective 2023

The College of American Pathologists (CAP) announced thirteen (13) new digital pathology Category III CPT codes beginning January 1, 2023. According to CAP, codes 0751T through 0763T will define clinical staff work associated with digitizing glass slides for primary diagnosis. 

The goal of the Digitization of glass microscope slides enables remote examination by the pathologist and/or in conjunction with the use of artificial intelligence (AI) algorithms. Category III add-on codes 0751T-0763T may be reported in addition to the appropriate Category I service code when the digitization procedure of glass microscope slides is performed and reported in conjunction with the Category I code for the primary service.

Do not report Category III codes in this subsection solely for archival purposes (e.g., after the Category I service has already been performed and reported), solely for educational purposes (e.g., when services are not used for individual patient reporting), solely for developing a database for training or validation of AI algorithms, or solely for clinical conference presentations (e.g., tumor board interdisciplinary conferences).

AMA has published the preliminary codes as follows:

• +0751T – Digitization of glass microscope slides for level II, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) (Use 0751T in conjunction with 88302)
• +0752T – Digitization of glass microscope slides for level III, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) (Use 0752T in conjunction with 88304)
• +0753T –Digitization of glass microscope slides for level IV, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) (Use 0753T in conjunction with 88305)
• +0754T – Digitization of glass microscope slides for level V, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) (Use 0754T in conjunction with 88307)
• +0755T – Digitization of glass microscope slides for level VI, surgical pathology, gross and microscopic examination (List separately in addition to code for primary procedure) (Use 0755T in conjunction with 88309)
• +0756T – Digitization of glass microscope slides for special stain, including interpretation and report, group I, for microorganisms (e.g., acid fast, methenamine silver) (List separately in addition to code for primary procedure) (Use 0756T in conjunction with 88312)
• +0757T – Digitization of glass microscope slides for special stain, including interpretation and report, group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents or immunocytochemistry and immunohistochemistry (List separately in addition to code for primary procedure) (Use 0757T in conjunction with 88313)
• +0758T – Digitization of glass microscope slides for special stain, including interpretation and report, histochemical stain on frozen tissue block (List separately in addition to code for primary procedure) (Use 0758T in conjunction with 88314)
• +0759T – Digitization of glass microscope slides for special stain, including interpretation and report, group III, for enzyme constituents (List separately in addition to code for primary procedure) (Use 0759T in conjunction with 88319)
• +0760T – Digitization of glass microscope slides for immunocytochemistry or immunohistochemistry, per specimen, initial single antibody stain procedure (List separately in addition to code for primary procedure) (Use 0760T in conjunction with 88342)
• +0761T – Digitization of glass microscope slides for immunocytochemistry or immunohistochemistry, per specimen, each additional single antibody stain procedure (List separately in addition to code for primary procedure) (Use 0761T in conjunction with 88341)
• +0762T – Digitization of glass microscope slides for immunocytochemistry or immunohistochemistry, per specimen, each multiplex antibody stain procedure (List separately in addition to code for primary procedure) (Use 0762T in conjunction with 88344)
• +0763T – Digitization of glass microscope slides for morphometric analysis, tumor immunocytochemistry (e.g., Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure, manual (List separately in addition to code for primary procedure) (Use 0763T in conjunction with 88360)

Pathology Coding Changes

The 2023 ICD-10-CM codes are going into effect on October 1, 2022, with more than 1,400 new diagnostic codes added. New codes must be submitted to all payers, including Medicare, Medicaid, and TRICARE. Since these codes indicate the necessity of medical services, failure to use the codes properly could result in denied claims and forfeiture of reimbursement for services rendered. 

Highlights of the new codes include: 

• OB/GYN code expansion (includes more than 400 new codes)
• Concussion/brain injury code expansion (includes more than 100 new codes)
• Dementia cod expansion (includes nearly 100 new codes)
• Methamphetamine overdose code expansion (new code category for poisoning by meth)
• Electric bike injury codes (allow for additional information about accident)        

More Coding Changes

In addition to the code expansions highlighted above, the following specialties and conditions will also see significant coding changes: 

• Atherosclerosis (I25.- series)
• Alcohol, cannabis, opioids, cocaine, and other substance use (F10.9 series)
• T-cell lymphoma (C84.4 series)
• Limb girdle muscular dystrophy (G71.03 series)
• Von Willebrand disease (D68.0 series)
• Candidiasis of the vulva and vagina (B37.- series)
• Acidosis (E87.2 series)
• Slipped upper femoral epiphysis (M93.0 series)
• Muscle wasting of the back (M62.5A series)
• Hemolytic-uremic syndrome (D59.3 series)
• Short stature (E34.3 series)
• Newborn sleep disorders (P28.- series)
• Patient noncompliance with provider’s orders (Z91.1 series)       

Let Coronis Health Maximize Your Coding Processes to Increase Revenue

Coding is one of the most challenging aspects to running any type of laboratory, with a direct impact on your revenue cycle and bottom line. Let Coronis Health take the stress out of coding, with services that get your claims right the first time. To learn more about our professional coding support, contact Coronis Health today. 

from
https://www.coronishealth.com/blog/new-codes-coming-is-your-practice-ready/