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2019 CPT coding changes for pathology

January 16, 2019

With the new year came several changes to pathology coding. In this post, we’ll address the three main areas of change.

Fine Needle Aspiration 

Starting with January 1, 2019 dates of service, there are changes to fine needle aspiration procedure codes. CPT code 10022 is deleted and codes 10004-10012 have been added. Most pathologists perform FNA without imaging guidance, so the common coding when the pathologist extracts the FNA specimen will include CPT 10021 and 10004 (if more than one lesion):

  • 10021 – fine needle aspiration biopsy, without imaging guidance, first lesion
  • 10004 – each additional lesion, without imaging guidance (list separately in addition to code for primary lesion)
  • Note 10004 is an add-on code which means it can only bill in conjunction with 10021. Select 10004 for each additional lesion.
  • CPT 10005-10012 include FNA with imaging guidance (ultrasound, fluoroscopic, CT, MR)

2019 CPT changes for Molecular

Molecular Pathology Tier 1 includes more than 45 new codes to conform to the parent code structure. There are also revisions for Tier 2 codes 81400-81406. There are changes and new codes to the Genomic Sequencing Procedure and Other Molecular Multianalyte Assays, the Multianalyte Assays with Algorithmic Analyses, Chemistry, and Proprietary Laboratory Analysis.

2019 Medicare Fee Schedule

The 2019 Medicare Physician Fee Schedule was published on Nov. 23, 2019. The adopted 2019 conversion factor of $36.0391 will result in up to a minus 2% payment rate change to pathology groups and independent laboratories based on work and practice expense RVU adjustments. Services with negative payment impact include CPT codes 10021, 85097, 88185, 88187, 88323-TC, 88361-TC and G0416-TC. Several positive payment rates include CPT codes 85390-26, 88346-TC, 88350-TC, 88358-TC and 88381-TC.

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