Coding and Payment

The College of American Pathologists (CAP) offers resources to assist pathology practices facilitate appropriate medical billing and coding efforts.

Billing and Coding Basics - How Pathology Practices Get Paid

Learn the various methods of payment as well as where to find billing and coding resources in this short video .

Payment methods to be reviewed include:

• Coding
• Fee for service (FFS)
• Technical Component (TC)
• Professional Component (PC)
• Global Method
• Part A

Alternative Payment Mechanism Resources

This unique glossary of alternative payment model terminology provides definitions and explanations for over 400 words, names, and abbreviations.

Centers for Medicare and Medicaid Services (CMS) Resources

• Clinical Pathology Interpretation Toolkit
  The toolkit includes information on implementing billing services based on CMS regulations.
• CMS Denials for Nonhospital Claims
  Practices who receive denials for nonhospital technical component services on the same day as hospital services can request reprocessing of claims, for denials claims processed on or after January 1, 2014, that meet the criteria.
• CMS Online Manual System
  Policies, and procedures based on statutes, regulations, guidelines, and directives for those administering CMS programs.
• Medicare Claims Processing Manual (Payment for Pathology Services)
• National Correct Coding Initiative Edits
  CMS developed coding policies.
• Medicare Coverage - National Coverage Determinations
  CMS determinations as to whether a service is reasonable and necessary

Current Procedural Terminology (CPT) Codes

• CPT Coding Resources

Direct Billing

Access the direct billing resources and find a list of states with direct billing, anti-markup, or disclosure laws.

HIPAA-Full Analysis of HITECH-HIPAA

The Department of Health and Human Services' Office for Civil Rights posted the HITECH Act's HIPAA modification final rule (PDF, 436 KB) to the Federal Register. AHIMA staff experts have released a full analysis of the lengthy rule.

International Classification of Diseases (ICD)

ICD-10-CM Resources

ICD-10-CM will be required for physician and clinical laboratory claims effective with October 1, 2015 dates of service.

Basic training for pathologists

The following resources will introduce you to ICD-10 and provide examples by specimen type of how to use free online resources

• Why ICD10?
  Introduction video to ICD-10 Coding
• ICD-10 Coding Basics
  Introduction to ICD10 coding overview for pathologists who need to code
• Demonstrating how to use free online resource ICD10data.com to do ICD-10-CM coding
  IC9-ICD10
  ICD-10-CM Coding Dermatology Examples
  ICD-10-CM Coding Gastrointestinal Examples

Pathologist specific ICD-10 Resources

• CAP Webinar – ICD-10: Is your practice on track for October 1, 2015 implementation?
• Centers for Disease Control ICD-10-CM Official Guidelines for Coding and Reporting 2015
  (eg, Chapter 2: Neoplasms) Essential guidance from CDC

General ICD-10-CM Resources

• American Association of Professional Coders
• ICD10Data.com
  Free online ICD-10-CM Coding "Book"

General Resources

• American Health Information Management Association (AHIMA)
• Workgroup for Electronic Data Interchange (WEDI)
• Health Information and Management Systems Society (HIMSS)

Select CMS Resources

• CMS ICD-10 Resources
  Trail head to CMS's ICD-10 resources
• Basic Introduction to ICD-10-CM
• Quick Reference Information
• NCDs and LCDs
  ICD-10 information

ICD-10-CM Coding Books

• Detailed Instruction for Appropriate ICD-10-CM Coding* ISBN-10:1622540654
• Advanced Anatomy and Physiology for ICD-10-CM/PCS* ISBN-10: 1622020103
• Principles of ICD-10-CM Coding 3rd Edition* ISBN-10: 1603599487
• Principles of ICD-10-CM Coding Workbook 3rd Edition* ISBN-10: 1603599495

National Provider Identifier (NPI)

Apply, maintain, or lookup National Provider Identifier for individuals and organizations NPI numbers.

Patient-Friendly Documents

Use the following files to connect your practice with your patients.

• Patient-Friendly Explanation of Pathologist Services
  This sample document is intended to help practices explain pathologist services to patients.
• Patient Friendly Agreement to Pay Pathologist Services
  This document is a sample of a hospital patient registration document for clinical pathology charges.

Provider Enrollment Chain and Ownership System (PECOS)

• PECOS General Information
• PECOS Enrollment Example - Screen shots
• PECOS Sample Letter to Refer