Pathology CPT Codes
Insights on CPT Codes
Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. Learn below the latest rules and regulations from our team of medical billing experts.
Read the latest updates on Pathology CPT codes
Navigating ‘Excludes 1’ & ‘Excludes 2’ Denials in Medical Billing
By: Tami Shaw, Client Manager At Lighthouse Lab Services, we’re committed to providing our clients with the insights and best practices needed to navigate the complexities of Revenue Cycle Management (RCM). Lately, we’ve received several inquiries from clients...
Is My Lab Required to Report PAMA Data?
Originally put into effect in 2017, the Protecting Access to Medicare Act (PAMA) requires many labs to report private payer data for clinical diagnostic lab tests to CMS every three years. The data is used to determine median payments in an effort to bring the...
New Novitas Process Set to Impact Pathology and Laboratory Claims
By: Billie Mildenberger, Director of Audit Services Note: Novitas announced this change will not take effect until Sept. 19, 2024. Starting Aug. 18th, 2024, Novitas will implement a process impacting newly effective molecular pathology and Proprietary Lab Analysis...
Effectively Navigating Medicare TPE Audits for Clinical Labs
By: Dyana Williams, Director, RCM Solutions Medicare's Targeted Probe and Educate (TPE) program is designed to identify and reduce improper payments, enhance compliance, and educate providers on proper billing practices. While TPE audits are intended to be educational...
How to Navigate MUE Denial Adjustments
By: Billie Mildenberger, Director of Audit Services, Lighthouse Lab Services RCM Case Study - MUE Denial Adjustments: Medically Unlikely Edits (MUEs) are used by Medicare Administrative Contractors (MACs), to reduce the improper payment rate for Part B claims. An MUE...
Why a Z-Code Identifier Doesn’t Equal MolDX Reimbursement
Beginning in the Spring of 2022, states participating in a Medicare MAC utilizing the MolDX program were subject to changes requiring registration for Infectious Disease testing if the panel in question is a lab developed test (LDT). The first step for anyone new to...
7 New Payer Contracts Obtained for Full-Service Medical Lab
Overview The client is an independent medical laboratory located in the Southeast of the U.S. that has served its local community for almost seven years. It is a full-service lab including blood culture, toxicology, and molecular testing. RELATED CASE STUDY: Expanding...
Case Study: Payer Denying Lab Outreach Work Due to Policy Error
By: Beth Madden, Client Manager, Lighthouse RCM Solutions The Issue Our RCM Solutions Team often digs into denials that continually stem from the same payer in order to help our clients better understand what is creating a payment logjam while ensuring future claims...
What is MolDX and When Do I Need a Z-Code?
Laboratories performing infectious disease testing and billing Medicare Part B within a MolDX jurisdiction are subject to a new Local Coverage Determination (LCD) that stands to significantly impact reimbursement for these services. Labs in the impacted MACs...