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Please review our pathology coding compliance example and let us know if you have any questions.
Cytopathology Audit
Physician Patient Missed Procedure Billed but Not Done Wrong Code
Document Deficiency 		Diagnosis Average Fee/CPT Revenue Gain/(Loss) Each CPT Comments
Smith AB02-2894(C1)      
Compliance Note: Suggest not using :"noncontributory for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $220/88305  -220  
Smith AB02-2849(C2) Missing number of NEUROENDOCRINE Markers    
  $150/88342 -300  
Smith AB02-2870(C3)      
Compliance Note: Suggest not using :"insufficient for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $175/88173 -175   
Smith AB02-2870(C4)      
Compliance Note: Suggest not using :"insufficient for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $220/88305 -220  
Smith AB02-3218(C4)      
Compliance Note: Suggest not using :"noncontributory for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target). 
   $220/88305 -220   
Smith AB02-2893(C5)      
Compliance Note: Suggest not using :"noncontributory for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $220/88305 -220  
Smith AB02-3295(C6)      
Compliance Note: Suggest not using :"noncontributory for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $220/88305  -220   
Smith AB02-3250(C7)      
Compliance Note: Suggest not using :"noncontributory for Dx". If possible report presence or absence of cells as appropriate. Payors will deny if audited (OIG target).
   $220/88305 -220  
Hematopathology Audit
Physician Patient Missed Procedure Billed but Not Done Wrong Code
Document Deficiency 		Diagnosis Average Fee/CPT
Revenue Gain/(Loss) Each CPT
Comments
Jones Z68000(H1)         Missing Pathologist's addtl Dx 288.8 790.09  
Future Local Medical Review Policy for Pathology payment will be influenced by inclusions into current Database for ICD9 Submissions.
Please review CMS Newsletter; Pathologist higher specificity Dx now required.
Jones Z33203(H2)         Missing Pathologist's addtl Dx.790.09  
Future Local Medical Review Policy for Pathology payment will be influenced by inclusions into current Database for ICD9 Submissions.
Please review CMS Newsletter; Pathologist higher specificity Dx now required.
Jones Z33335(H3)         Missing Pathologist's addtl Dx.288.9  
Future Local Medical Review Policy for Pathology payment will be influenced by inclusions into current Database for ICD9 Submissions.
Please review CMS Newsletter; Pathologist higher specificity Dx now required.
Surgical Pathology Audit
Physician Patient Missed Procedure Billed but Not Done Wrong Code
Document Deficiency
Diagnosis		 Average Fee/CPT
Revenue Gain/(Loss) Each CPT
Comments
Johnson S99-11415(S1)      
Missing Pathologist's addtl Dx 464.10
  
Future Local Medical Review Policy for Pathology payment will be influenced by inclusions into current Database for ICD9 Submissions.
Please review CMS Newsletter; Pathologist higher specificity Dx now required.
Franklin S99-11150(S2)     Lung Wedge Bx=88307
  $220/88305
$350/88307		 -130  
Howard S99-12479(S3)      
Missing documentation for Microorg. Stain.
   $85/88312 -85   
Johnson S99-11353(S4) IF Study GAMC3(#?)         $125/88346 -375  
Monroe S99-10920(S5) H pylori stains done 88312x2 or 88342x2         $85/88312 or $150/88342 -150  
Monroe S99-10920(S6)   CMV/88342 not documented  
Do Not Bill Until Test Completed (OIG Target).
   $150/88342 -150  
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