When our billing company files a claim (s) for you to your insurance coverage, they must also file a CPT-4 code for each item of "service" [we must follow federal demands for billing] and ICD-9 codes for diagnosis. Because so many important (though possibly rare) diseases are occult (not obvious) in their early phases, nearly any tissue or body part removed is sent to pathology for examination (also, sometimes insurers deny your claims payment without proof of a pathology exam). Then, for each specimen that was sent to us as a separately identified specimen requiring separate services, we must file an ICD-9 diagnosis code. So, you may have been put to sleep for what you thought was one operation; but it resulted (unbeknownst to you) in 1-15 specimens. Even more confusing, if we perform special tests (special stains or decalcification) on the specimen, there are additional CPT-4 charge codes. All of this should be documented in the pathology report (though it may not be obvious to you if you read it). Additionally, there may be charges for our general help in constantly & contractually influencing that the lab perform in a way (24/7/365) that works in your best interests. Pathology CPT coding resource site: at CAP.

• Pap smears: this is complex [HPV test denial]
• Breast surgery
• Thyroid or parathyroid surgery
• Prostate surgery: [core biopsies]  [other]
• Gynecological biopsies or surgery:
• You had a baby: had tubes tied or pathology exam of placenta
• General, thoracic, or vascular surgery:
• You had a biopsy by radiologist in radiology; or by a pathologist
• Lung problems:
• Bone marrow specimens:
• Dermatologist and skin biopsies and surgery:
• Orthopedic and/or podiatric bone, joint, or foot surgery:
• Bleeding or clotting problem consultations:
• Ear, Nose, and Throat (ENT) and/or oral-surgery/dental surgery:
• Gastrointestinal (from endoscopy) and liver biopsies:

(posted 26 April 2001; latest update 15 June 2006)