Laboratory Administration & Management of Pathology Practices
Cytology
Cytology billing


Topic Completed: 1 March 2013

Minor changes: 24 December 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Cytology billing[TIAB]

Joseph D. Jakowski, M.D.
Susan Meanor, R.T., R.D.M.S.
Page views in 2019: 15
Page views in 2020 to date: 192
Cite this page: Jakowski JD, Meanor S. Cytology billing. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/managementlabcytologybilling.html. Accessed July 7th, 2020.
Documentation and billing in USFNA
  • Currently, neither practice accreditation nor personal certifications are required for reimbursement of USFNA procedures or for US examinations (except for noninvasive vascular US studies, which pathologists do not perform, as some states require certification for reimbursement)
  • To ensure proper documentation for reimbursement for an USFNA procedure or US exam, the practitioner must document these elements in the medical record:
    • Demographics including facility name, patient name, date and time of exam, etc.
    • Relevant patient clinical information
    • Medical necessity for the examination (including ICD-9 code)
    • Who performed the US examination
    • Scope of the examination (i.e. limited versus complete US exam):
      • Pathologist will almost always perform a limited US exam
      • Limited US exam: evaluation of a limited number of organs or limited portion of region evaluated
      • Complete US exam: one that attempts to visualize and diagnostically evaluate all of the major structures within the anatomic region
    • US report with description of study, findings and impression, or limitations, etc.
    • US image retention with permanent storage and availability for future review
Current Procedural Technology (CPT)™ coding in USFNA and US medicine (partial list)
Procedure codes
10022
Fine needle aspiration; with imaging guidance

76942
Ultrasound guidance of needle placement (e.g. biopsy, aspiration, imaging supervision and interpretation)

Pathology professional and technical codes
88172
Cytopathology, evaluation of fine needle aspirate; immediate evaluation for adequacy of specimen(s)

88173
Cytopathology, evaluation of fine needle aspirate; final interpretation and report

88305
CELL BLOCK: level IV - surgical pathology, gross and microscopic examination

88104
Cytopathology, fluids; smears with interpretation

Limited ultrasound examination CPT codes
  • The pathologist will most always perform a focused or goal directed US that should be billed as a limited US examination
  • A limited examination may be defined by the CPT code
  • In addition, CPT modifiers might need to be added to the examination

76857
Ultrasound, BUTTOCK and PERINEUM, real time with image documentation

76705
Ultrasound, ABDOMINAL WALL and LOWER BACK, real time with image documentation

76536
Ultrasound, HEAD and NECK (e.g. thyroid, parathyroid, parotid), real time with image documentation

76604
Ultrasound, CHEST WALL and UPPER BACK, real time with image documentation

76645
Ultrasound, BREAST(s) (unilateral or bilateral), real time with image documentation

76882
Ultrasound, AXILLA, GROIN, UPPER and LOWER EXTREMITY, nonvascular, real time with image documentation
CPT E/M codes in USFNA and US medicine (partial list)
Evaluation and management (E/M) codes (i.e. office visit codes)
  • Evaluation and Management E/M codes are billed for the history, physical examination and medical decision making process documented by the pathologist who sees patients in an outpatient setting for evaluation and performance of a fine needle aspiration

NEW patient E/M codes
  • Defined as a patient in which:
    1. No physician from same specialty / group has seen the patient for services before
    2. No professional services were rendered in the last 3 years for the patient
  • Related E/M Codes 99201, 99202 etc.

99201
Office or other outpatient visit (10 min) for the evaluation and management of a new patient which have these components or criteria for documentation and billing purposes
  1. Requires 3 key components:
    1. Focused history
    2. Focused exam
    3. Straightforward medical decision
  2. Patient has a self limited or minor problem:
    1. Minimal number of diagnoses or management options
    2. Minimal or no data to be reviewed
    3. Minimal risk of complications, morbidity, mortality
  3. Physician time: 10 minutes

99202
Office or other outpatient visit (20 min) for the evaluation and management of a new patient which have these components or criteria for documentation and billing purposes
  1. Requires 3 key components:
    1. Expanded problem focused history
    2. Expanded problem focused exam
    3. Straightforward medical decision
  2. Patient has a low severity or moderate severity problem:
    1. Limited number of diagnoses or management options
    2. Limited amount or complexity of data to be reviewed
    3. Low risk of complications, morbidity, mortality
  3. Physician time: 20 minutes

Established patient E/M codes
  • Established Patient E/M Codes are for patients that have been previously seen or in which FNA services have been rendered by the group / specialty within the last 3 years (e.g. repeat FNA biopsy or repeat cyst drainage)
  • Related E/M Codes 99211, 99212, etc.
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