Dermatopathology Billing Services

Specimen counting and level selection

A specimen is a separately identified and separately submitted piece of tissue, not a slide and not a block. Two lesions submitted in one container are one specimen; four punches in four containers are four. Getting this wrong in either direction is the fastest route to either lost revenue or a refund demand. We count from the requisition and the gross description, and we apply 88304 and 88305 by the tissue type listed in the CPT descriptor rather than by habit.

Component splitting for in-house and outside labs

• Modifier 26 for the professional interpretation when the practice reads slides processed elsewhere.
• Modifier TC for the technical component when the practice runs the lab but a separate pathologist reads.
• Global billing when the practice owns both, with place-of-service accuracy so the claim is priced correctly.
• Correct application of the anti-markup rules and physician self-referral disclosure requirements where they apply.

Stains, immunohistochemistry and molecular add-ons

• 88312, 88313 and 88314 for special stains, reported per block and per stain as the descriptors require.
• 88341 and 88342 for immunohistochemistry, with 88344 for multiplex, counted per specimen and per antibody correctly.
• Medical necessity documentation for stains ordered on melanocytic and lymphoid lesions, which draws payer scrutiny.
• Melanoma prognostic gene-expression profiling billed with the correct code and the payer's coverage policy checked first.