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Chapter 33 : Correct Coding of Billable Services in the Clinical Laboratory
This chapter explains the importance of using the standardized coding systems recognized by the payors. It discusses laboratory responsibilities to ensure that correct and complete coding has been done and talks about the importance of the ICD-9-CM coding system and its relationship to proper billing. The chapter also discusses the fundamental principles of correct and complete coding. All aspects of effective financial management of the clinical laboratory begin with correct and complete coding for all services rendered. Professional services are identified by specific CPT-4 codes found in the anatomic pathology and cytology subsections, and by two specific codes in a clinical pathology consultation section. Modifiers are another important component of the CPT system, and are comprised of two-digit numbers which are attached to a specific code prior to the billing process. Since laboratory procedures are constantly evolving, particularly with the emergence of new technology, it is necessary for the CPT-4 system to undergo regular updates. The CPT system is obviously firmly entrenched in laboratory management as the primary tool for procedure coding and subsequent billing of laboratory services. Revenue codes comprise a system for categorizing and billing services which is recognized by Centers for Medicare and Medicaid Services (CMS) and most third-party payors. Requisitions may be manual (hard copy) or electronic but should be designed to facilitate the capture of all of the required data for accurate processing of an order as well as effective processing of a claim or invoice. Claims submitted to third-party payors can be electronic or manual in nature.
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- Disease Management