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Current Procedural Terminology Coding for Surgical Pathology: A Review and One Academic Center's Experience With
Audrey Deeken-Draisey1, Allison Ritchie1, Guang-Yu Yang1
1From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Archives of Pathology & Laboratory Medicine
|March 28, 2018
Summary
Accurate Current Procedural Terminology (CPT) coding is vital for healthcare reimbursement and compliance. A multidisciplinary approach involving physicians and coders ensures coding accuracy in surgical pathology.
Area of Science:
- Medical coding
- Health services research
- Surgical pathology
Background:
- The Current Procedural Terminology (CPT) system is essential for medical procedure and service reporting.
- Accurate CPT coding is critical for healthcare provider reimbursement by Medicare and other payers.
- Errors in CPT coding can lead to significant financial penalties and revenue loss.
Purpose of the Study:
- To review the history, current state, and principles of CPT coding in surgical pathology.
- To present an institutional experience with pathologist involvement in CPT code verification.
- To identify common CPT codes requiring modification in surgical pathology.
Main Methods:
- Literature review of CPT coding principles and resources.
- Analysis of billing quality data from a single institution.
- Implementation of a pathologist-led CPT code review system.
Main Results:
- CPT coding accuracy is crucial for financial and regulatory compliance in healthcare.
- A multidisciplinary approach involving physicians and coders is recommended for optimal accuracy.
- Pathologist involvement in CPT coding can identify and correct errors.
Conclusions:
- Physician involvement in CPT coding is debated but beneficial.
- A collaborative approach between healthcare providers and professional coders enhances accuracy.
- Implementing pathologist review of CPT codes improves accuracy and compliance in surgical pathology.